Pre-Enrollment Form
Please complete this form if you are interested in enrolling your student at Willamette Leadership Academy. This form provides us with contact information for your family and a brief overview of your student and why you are interested in our program.

Please note, if any of the information in this form turns out to be incorrect, Willamette Leadership Academy reserves the right to reconsider placement. By submitting this form, you are agreeing that all the information is correct to the best of your knowledge.
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Email *
What is today's date? *
Which school year are you interested in applying for?
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What is your student's first and last name? *
What is your student's date of birth? *
What is your full name and relationship to the student? *
What is the best contact number for you? *
What is the current address for your student? *
How did you hear about Willamette Leadership Academy? *
Why are you considering Willamette Leadership Academy? *
What school district are you currently attending and living in? *
What School is your student currently attending? *
What grade is your student currently in? *
Does this student currently have any siblings attending WLA? *
How is your student doing academically at their current school? *
What is your student's attendance history? *
Has your student previously attended Willamette Leadership Academy? *
If yes to the above question, what are the previous dates of attendance? Please note, any returning students must be in good standing with WLA and may require a meeting with school administrators prior to re-enrolling.
Does your student have any learning disabilities? If yes, please describe what their challenges are. *
Is your student on an IEP? *
If you answered "yes" to the above question, please let us know what your student's current services are and the name of their current Special Education teacher. Please submit the most recent copy of your student's IEP so that our Resource Team can review it to determine if WLA is the proper placement for your student.
Does your student have a 504 plan? *
If you answered "yes" to the above question, please let us know what current services your student is receiving. Please also submit the most recent copy of the 504 plan for review to determine if WLA is the proper placement for your student.
Are you having any of the following issues with your student? *
Please describe your student's overall personality inside and outside of school. *
Has your student been expelled or currently pending an expulsion? *
If you answered "yes" to the above question, please describe the circumstances surrounding the current expulsion or pending expulsion.
WLA is a very physical program that includes marching, running, push ups, and other physical activities. Does your student have any physical limitations that would prevent them from fully participating in our program? *
Is there any other information about your student that you would like to share with us? *
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