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EEA Learning Academy                      Enrollment Interest Application                    24-25 School Year
Wausau School District
Attention: Dr. Shannon Young, EEA Principal
2607 N. 18th St. 
Wausau, WI 54403
syoung@wausauschools.org
715-261-0636

* Note- the questions on this application do not have any bearing on a student's acceptance into EEA.  The purpose of this application is to help the EEA staff provide you with next steps in the enrollment process for the student.
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Student name (first, middle, and last)
Student date of birth (MM/DD/YYYY)
MM
/
DD
/
YYYY
Student email address
Gender
Clear selection
Current grade in school
Semester of requested enrollment
Clear selection
Provide the name of your current school and school district.
Have you had any attendance / truancy issues ? *
Required
Have you had any disciplinary / pre-expulsion-expulsion issues? *
Required
Home address including city, state and zip code
Home phone number
Parent/Guardian name(s) (first and last)
Parent/Guardian main phone number
Parent/Guardian email address
Does the student currently receive special education services through an IEP (Individual Education Plan) or did the student ever receive services in the past?
Clear selection
Are there any health conditions or medications that need to be taken at school? 
If the student currently has an IEP or 504, who is the student's case manager?
Does the student currently have a 504 plan?
Clear selection
Are you currently living within the boundaries of the Wausau School District?
Clear selection
What has your school experience been up to this point? Share both positives and negatives. *
Please indicate what you are looking for in a new school?  What are you hoping it will be like?   *
Where or how did you hear about EEA?
Please share any questions that you have at this time.
If you would like to schedule a tour, please select one of the following dates.   *
If you chose "other" for  tour date, comment here. 
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