Coastal Leadership Academy Enrollment Application
Email address *
Today's Date *
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Student's First and Last Name *
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Your child's Date of Birth: *
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Your Child's Gender *
Current Grade Level for 2019-2020 *
What term is the student applying to attend? *
What school is your child currently attending *
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Please name the base high school your child is zoned to attend *
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Parent/Guardian First and Last Names: *
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Parent/ Guardian Phone #: *
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Parent / Guardian Street Address: *
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Parent / Guardian City, State, and Zip Code *
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What is your county of residence (Horry, Georgetown, etc.) *
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How did you hear about us? *
Referred by: *
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Would you like to schedule a tour? *
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