Online Application Submission
* Required
Prospective student's first name
*
Your answer
Prospective student's last name
*
Your answer
Date of Birth
*
Example: mm/dd/yyyy
MM
/
DD
/
YYYY
City & State of Birth:
*
Your answer
Gender
*
Female
Male
What is your primary language?
*
Your answer
Is your student Hispanic/Latino?
*
No
Yes
Ethnicity
*
(I) American Indian/Alaskan Native
(A) Asian
(B) Black/African American
(H) Hispanic
(P) Native Hawaiian/Other Pacific Islander
(W) White
Required
Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
What county do you live in?
*
Choose
Franklin
Delaware
Licking
Fairfield
Madison
Pickaway
Union
Primary phone
*
Example: 555-555-5555
Your answer
Is this phone number your
*
Cell phone
Home phone
Work phone
Required
What is your email address
Your answer
What is your preferred method of contact?
*
Email
Phone
Required
I am applying to enroll for:
*
January 2020 (2nd semester-2019-20)
School year 2020-21
Where is your student currently attending school?
*
Your answer
What school district do you live in?
*
Your answer
What was your student's 2019-20 grade level?
*
8
9
10
11
12
What will be your student's grade level for 2020-21?
*
9
10
11
12
Has your student repeated a grade level?
*
Yes
No
If you answered yes, what grade level was repeated?
Your answer
Does student currently have a sibling at:
*
No
Yes
GEMS (Graham Elementary and Middle School)
The Charles School at Ohio Dominican University
The Graham School
No
Yes
GEMS (Graham Elementary and Middle School)
The Charles School at Ohio Dominican University
The Graham School
Does your student have an IEP/ETR?
*
No
Yes
Does your student have a current 504 learning plan?
*
No
Yes
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