An Achievable Dream VIRGINIA BEACH Student Information Form (2025-2026 School Year)
We are delighted you are interested in your student attending the Achievable Dream program.  This sheet is to be completed by parents / guardians for each student so that we may have accurate records for the students.  This sheet will become a permanent part of his/her records, so it is imperative that the information is correct. Please complete this form for each student prior to attending your informational meeting. 
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What is your email address? *
Student -Last Name *
Student -First Name *
Student -Middle Name *
Birthday *
MM
/
DD
/
YYYY
Student Number *
Gender *
Current School *
Current Grade *
Number of Siblings -Sisters *
Number of Siblings -Brothers *
Number of Siblings (current or former students) in An Achievable Dream Academy *
List the First Name, Last Name and School ID# of Each Sibling in An Achievable Dream Academy:
Name of Parent or Guardian Having Legal Custody: *
Relationship to Student *
Name of Parent or Guardian Having Legal Custody:
Relationship to Student
Are you a single Parent? *
Who does the student reside with? *
(If Other Specify Name and Relationship)
Highest Grade completed by Mother *
Highest Grade completed by Father *
Do you live in? *
(If other, please explain)
Street Address *
City *
State *
Zip Code *
Home Phone Number
(000) 000-0000
Work Phone Number
(000) 000-0000
Cell Phone Number
(000) 000-0000
Does the child participate in the Free Lunch Program? *
Does the child participate in the Reduced Lunch Program? *
How Many People Live in Your Household? *
Does your child have an individual education plan (IEP) or have other accommodation needs? *
If yes, under what category is he/she served?
Student Uniform Size *
Did someone refer you to the program? If so, please list their name.
How did you hear about An Achievable Dream? *
List any extracurricular activities (school and/or community in which your child participate. Include the number of hours you spend per week on each activity. *
Please provide a school staff member's name who knows your child to provide a recommendation. We will send them an email to complete the recommendation. *
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