North Star Montessori Academy

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2025-2026 School Enrollment Form

To enroll a new student at NSMA:

Complete this entire form
Provide school with copies of: Official Birth Certificate, Immunization Record or Waiver. Student will not be officially enrolled until these documents are received.

Email *

Student Grade for 2025-2026 *

Last Name & Suffix (Jr., II, etal) if applicable *

Legal First Name, NOT nickname *

Middle Initial

Preferred Nickname, if applicable

Date of Birth *

Birthplace (City, State) *

Gender *

Female

Male

Student Resides with: *

Parents

Mom

Dad

Other:

Residential Address (Street #, City, State, Zip) *

Parent/Guardian Name(s) *

Parent/Guardian(s) Phone Number(s) *

School District of Residence *

Racial/ Ethnic Information for Michigan Department of Education Statistics Primary and/or Secondary Ethnicity. (Select all which apply) *

American Indian or Alaska Native

Asian American (Far East, SE Asia, Indian)

Native, Guam, Samoa, or Other Pacific Islander

Black or African American

White

Hispanic or Latino (Cuba, Puerto Rico, South or Central America or other Spanish culture or origin)

Required

Special Education Services *

Speech Therapy

Social Work

Resource Room

Self-contained classroom

504

IEP - If your student has an IEP, call NSMA at (906) 226-0156 to schedule a meeting with the Special Education Coordinator

None

Required

What is the primary language at home? *

English as Second Language *

Yes

Check applicable paragraph: *

The undersigned affirms that the above named student HAS NOT BEEN suspended or expelled from any public or private school in Michigan or any other state for an offense involving weapons, alcohol, vape or drugs, or for the willful infliction of violence against persons and or property committed on school premises, at any school sponsored event , or on a public or private conveyance providing transportation to and from a school or school sponsored activity,

The undersigned affirms that the above named student HAS BEEN suspended or expelled from a public or private school in Michigan or another state for one or more offenses involving weapons, alcohol, vape or drugs or for the willful infliction of injury to another person or for any act of violence against persons and or property committed on school premises, at any school sponsored event, or on public or private conveyance providing transportation to and from a school or school sponsored activity.

If the above named student has been suspended or expelled, explain the circumstances in detail. Include the name of the school, dates of suspension or expulsion along with a description of the actions that proceeded the suspension or expulsion determination.

If no prior discipline type in "n/a"

Name of previous school attended *

Address of previous school attended *

Last school year attended at previous school

(ex: 2019-2020)

How did you hear about North Star Montessori Academy? *

Prior to completing this application, have you taken a school tour and/or had a meeting with an administrator? *

Does this student have any sibling(s) currently enrolled at NSMA? Please list name & grade level.

Are there other sibling(s) who are applying to NSMA?

Below space is available for additional comment/ information, if needed:

I authorize North Star Montessori Academy to release my child’s immunization record and personally identifiable information to the Michigan Department of Health and Human Services and Local Health Department. I understand this information will be used to improve the quality and timeliness of immunization services and to help schools comply with Michigan Law. This includes any immunization information and limited personally identifiable information from the school.

You may withdraw your consent to share this information in writing at any time.

Yes

Signature of parent or legal guardian completing this form *

Date *

YYYY

EQUAL EDUCATION OPPORTUNITY

North Star Montessori Academy does not charge tuition and does not discriminate in its pupil admissions policies or practices on basis of intellectual or athletic ability, measures of achievement or aptitude, status as a handicapped person, or any other basis not permitted by Michigan's public schools.

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