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Madison High School 2021-2022 Open Enrollment Application
This is a preliminary application. The Madison Office will contact you to complete the enrollment process.
Email *
Student Information 2021-2022
(As it appears on birth certificate)
Last Name *
First Name *
Middle Name *
Current Age of Student *
School District *
Gender *
Is student currently being homeschooled? *
Address *
City *
State *
Zip *
Is this a temporary residence? *
Date of Birth *
MM
/
DD
/
YYYY
State & Country of Birth *
If outside the US, when did the student enter the US? *
MM
/
DD
/
YYYY
Student is currently under disciplinary review or suspension procedures at current school. (If yes, you must supply documentation,) *
Student has been expelled in the last 180 days. (If yes, you must supply documentation.) *
Grade in August of 2021 *
Parent/Legal Guardian Information: For Contact Purposes
Parent/Legal Guardian Name *
Relationship *
Address *
City *
State *
Zip *
Preferred Phone Number *
Alternate Phone (If different than above.)
Work Phone Number *
Workplace *
Hours of Employement *
Parent/Legal Guardian Email Address *
Student Resides with *
Required
Sibling Information: (List only siblings that are or will be attending Madison Academy).
MUST STILL COMPLETE APPLICATION FOR EACH.
Sibling #1 Name
Gender
Clear selection
Grade in August of 2021
Sibling #2 Name
Gender
Clear selection
Grade in August of 2021
How did you hear about Madison? (Select All That Apply)
Referral - Name of Referral
Submit
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