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2024-2025 Momentum Academy Open Enrollment Application
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* Indicates required question
Email
*
Your email
Student Information 2024-2025
(As it appears on birth certificate)
Last Name
*
Your answer
First Name
*
Your answer
Middle Name
*
Your answer
Current Age of Student
*
Your answer
School District
*
Your answer
Gender
*
Male
Female
Is student currently being homeschooled?
*
Yes
No
Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Is this a temporary residence?
*
Yes
No
Date of Birth
*
MM
/
DD
/
YYYY
Was your child born outside the US or Puerto Rico?
*
Yes
No
What is the first date of enrollment in school in the United States?
*
MM
/
DD
/
YYYY
Preferred family language of communication?
*
Your answer
Student is currently under disciplinary review or suspension procedures at current school. (If yes, you must supply documentation,)
*
Yes
No
Student has been expelled in the last 180 days. (If yes, you must supply documentation.)
*
Yes
No
Grade in August of 2024
*
Choose
Pre-K
K
1
2
3
4
5
6
7
Parent/Legal Guardian Information: For Contact Purposes
Parent/Legal Guardian Name
*
Your answer
Relationship
*
Your answer
Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Preferred Phone Number
*
Your answer
Alternate Phone (If different than above.)
Your answer
Work Phone Number
*
Your answer
Workplace
*
Your answer
Hours of Employement
*
Your answer
Parent/Legal Guardian Email Address
*
Your answer
Student Resides with
*
Both Parents
Mother
Father
Guardian
Other:
Required
Sibling Information: (List only siblings that are or will be attending Momentum).
MUST STILL COMPLETE APPLICATION FOR EACH.
Sibling #1 Name
Your answer
Gender
Male
Female
Clear selection
Grade in August of 2024
Choose
Pre-K
K
1
2
3
4
5
6
7
Sibling #2 Name
Your answer
Gender
Male
Female
Clear selection
Grade in August of 2024
Choose
Pre-K
K
1
2
3
4
5
6
7
How did you hear about Momentum? (Select All That Apply)
Newspaper
Commercial
Billboard
Mailer
Open House
Website/Social Media
Other:
Referral - Name of Referral
Your answer
Submit
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