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Lincoln Alternative Academy Parent / Guardian Application 2020-2021
Parents - If your student is under 18 yrs. old, please complete this parent application for your student to be considered for enrollment at Lincoln Academy. All responses will be kept confidential and will be used as part of the intake / screening process for student enrollment at Lincoln Alternative Academy. Thank you!
* Required
Email address
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Your email
Student's Last Name
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Your answer
Student's First Name
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Your answer
Parent or Guardian Last Name
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Your answer
Parent or Guardian First Name
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Your answer
Date filled out
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MM
/
DD
/
YYYY
Date of birth for student
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MM
/
DD
/
YYYY
Age of Student
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Your answer
Living Address
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Your answer
Please list the town the student lives in.
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Your answer
Please list who the student live with.
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Your answer
Your Cell Phone Number XXX-XXX-XXXX
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Your answer
Grade of Student
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9th
10th
11th
12th
12th and beyond
Is the student currently enrolled in school?
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Yes
No
If you answered no, when did your student last attend school? List the Month and Year. (ex. April 2020).
Your answer
What school was the student last enrolled?
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Your answer
About how many days of school did your student miss last school year?
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Less than 10
Less than 20
More than 20
Why was the student absent from school?
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Your answer
Has the student been suspended from school?
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Yes
No
If your student has been suspended from school, list the reason and length of the suspension.
Your answer
Has the student been suspended for an entire year?
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Yes
No
If your student has been suspended from school, list the reasons and for how many days.
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Your answer
Please check the following criteria that applies to your student which should be considered for enrollment at Lincoln Academy.
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Academic - Behind on Credits
Absences from School
Behavior Difficulties
Family Issues
Pregnant or Parenting
Involvement with the Court System
Financial Issues
Health Issues
Mental Issues
Substance Abuse - Drugs or Alcohol
Involvement with Juvenile Justice - OJA, probation, etc.
DHS Custody
Dropout - Seeking to get back into school
Other
Required
If you marked "Other" on the previous question, please explain.
Your answer
How did you hear about Lincoln Academy?
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SHS or SJHS Counselor Referred my student for enrollment
Family Friend(s)
We have family members who have attended Lincoln Academy
We are new to town and heard about Lincoln Academy
If you answered family members to the previous question, please list their names.
Your answer
Is your student currently involved in the court system?
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Yes
No
If you answered yes to your student being involved in the court system, please share information as to their involvement (ex. truancy court, etc.)
Your answer
Has your student ever received special services for being on an Individualized Education Plan (IEP)?
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Yes
No
If you answered yes to your student being on an IEP, what areas of support did you receive (Math, Reading, Behavior, etc.)?
Your answer
Has your student ever received special services for being on a 504 or Health Plan?
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Yes
No
If you answered yes to your student being on a 504 or Health Plan, why were you placed on one?
Your answer
What do you feel are the problems facing your student in school?
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Your answer
Does your student have any health problems, physical limitations, or other information we should be aware if your student attends school at Lincoln Academy?
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Your answer
How will your student get to and from school each day? Will they need to ride the bus?
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Your answer
What are the educational goals you have for your student?
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Your answer
Listed are 10 character words that Lincoln Academy uses daily to teach Life Skills. Please select at least 3 character traits you would like for us to focus on with your student.
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Trustworthiness
Citizenship
Respect
Honesty
Responsibility
Courage
Fairness
Diligence
Caring
Integrity
Required
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