26-27 COSSA Academy Student Registration 
Please complete the 2026–2027 Academy Student Registration Form to enroll for the upcoming school year. Students who enroll at the Academy must meet the federal definition of at-risk. Please consult with your district/high school counselor for assistance in determining eligibility.  Be sure to review your information carefully before submitting. If you have any questions or need assistance, please feel free to reach out to the COSSA office.
Email *
Student's Full Name (First, Middle, Last)
Date of Birth
Gender
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Home School/District 
Expected Grade Level during the 26-27 School Year 
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Mailing Address
City
Zip Code
Physical Address - please include address, city, & zip code (skip if this is the same as mailing address) 
Parent/Guardian Name(s)
Parent/Guardian Phone Number
Parent/Guardian Email Address
2nd Parent/Guardian Name(s)
2nd Parent/Guardian Phone Number
2nd Parent/Guardian Email Address
Emergency Contact Name & Phone Number
Is the Student a Parent?
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Is the Student on an IEP?
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Is the Student on a 504?
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Is the Student an English Learner?
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