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New Life Preparatory Academy
Application for Admissions
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* Required
Student Last Name
*
Your answer
Student Preferred Name (nickname)
Your answer
Student Address
*
Your answer
City and State
*
Your answer
Zip Code
*
Your answer
Student Cell Number
*
Your answer
Student Primary Email Address
*
Your answer
Social Security Number
*
Your answer
The best time to contact you:
*
A.M.
P.M.
Call
Text
Required
Date of Birth
*
Your answer
Parent/Gardian or Spouse Contact Information
Parent/Gardian or Spouse First and Last Name
*
Your answer
Parent/Gardian or Spouse Relationship to You
*
Mother
Father
Guardian
Spouse
other
Required
Parent/Gardian or Spouse Email Address
*
Your answer
Parent/Gardian or Spouse Cell Number
*
Your answer
Does Your Parent/Guardian or Spouse Text
*
Choose
Yes
No
Employer
Your answer
Work/Cell Phone Number
Your answer
Emergency Contact #1
*
Your answer
Emergency Contact #1 Address
*
Your answer
Emergency Contact #1 Phone
*
Your answer
Emergency Contact #2 Phone
*
Your answer
ACADEMIC INFORMATION
Highest Level of Education
*
Your answer
Please list any certifications, licenses, or diplomas you possess:
*
Your answer
Name of last school attended and Year
*
Your answer
Reason for leaving
*
Your answer
Reason for attending New Life
*
Your answer
Personal Information
So we can start to get to know you a little better, please answer the following questions.
Have you ever taken an online class before?
*
Choose
Yes
No
Other
If you have taken an online class before, please include the name of the school(s) and course(s) you have taken
*
If this is your first online course, please type "I have not taken an online course before".
Your answer
Do you have a computer at home?
Choose
Yes
No
Other
If you do have a computer at home, does it have a Windows or Mac operating system?
Choose
Yes
No
Other
What do you hope to accomplish at New Life Preparatory Academy?
*
Your answer
Is there anything else you would like to share with us about yourself?
Your answer
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