Jalen Rose Leadership Academy 2018-2019 Online Application
Thank you for your interest in joining the JRLA family! To complete your application please bring the following documents to the school office or email them to garcian@jrladetroit.com with the name of your scholar in the subject line

1. Birth Certificate
2. Transcripts (for incoming 9th graders the most recent report card)
3. Current immunization records
4. Copy of parent/guardian photo ID
5. Special Education 504 Documentation

Student Full Name (First Name + Last Name) *
Your answer
Address
Your answer
City and Zip
Your answer
Student's Date of Birth (00/00/0000)
Your answer
Student's Gender
Student's Race
Current Grade *
Required
Current School Attending
Your answer
Does the scholar have any siblings that attend JRLA?
If Yes, Please list the sibling's name
Your answer
Special Education
Parent and Guardian Information
Please enter primary parent/guardian information below
Primary Parent/Guardian Full Name (First+ Last Name)
Your answer
Address
Your answer
City and Zip
Your answer
Parent/Guardian Primary Phone *
Your answer
Email Address *
Your answer
Relationship to Student *
Your answer
Additional Parent and Guardian Information
Not required to fill out if only one parent or guardian
Parent/Guardian Full Name (First+ Last Name)
Your answer
Address
Your answer
City and Zip
Your answer
Parent/Guardian Phone *
Your answer
Email Address *
Your answer
Relationship to Student *
Your answer
With whom does the child reside? *
Your answer
If you have any questions or comments for us please include them below *
Your answer
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