Enrollment - Motiv8 - The Prep Academy

Student Information

First Name

Middle Name

Last Name

Gender

Date of Birth

Place of Birth

Race

Verify Email

Phone

Driver's Licence

Address

City

State

Zip

Academic Information

Last Grade Completed

If you were in school now or recently, what is your current grade level?

Last School

Do you have an IEP (Individualized Education Plan)?

County / Parish Name

Student ID#

Location / City

State

Do you have a 504 Plan?

Last Date Of School Attendance

How did you hear about the school?

Enter the details

Parent or Guardian Information

First Name

Last Name

Suffix

Phone

Regional Office

Address same as student

Address

City

State

Zip

Parent or Guardian Information 2 / Additional Contact

First Name

Last Name

Suffix

Phone

Regional Office

Address same as student

Address

City

State

Zip

DPS&C Reporter Information

Name

Phone

Parole/Probation Officer / Parent Information

Name

Phone

References

How did you hear about us?

Interests

What are you interested in after you graduate?

Select this checkbox and fill the mailing address if you need a device.

Are you wanting to join the workforce or go to college?

Street Address

City

State

Zip

Primary/Home Language Survey for All New Incoming Students

Questions for Parents or Guardians

What is the most common language(s) spoken in your home?

Which language did your child learn first?

Which language does your child use most often at home?

In what language do you most often speak to your child?

What language does your child use with friends?

Has your child received ESL/EL services previously?

Yes No

In what language would you prefer to receive information from the school?

Louisiana Student Residency Questionnaire

Disclaimer: This questionnaire is intended to address the McKinney-Vento Act. Your child may be eligible for additional educational services through Title I Part A, Title I Part C Migrant, Individuals with Disabilities Education Act (IDEA) and/or Title IX, Part A, Federal McKinney-Vento Assistance Act, 42 U.S.C.11435. Eligibility can be determined by completing this questionnaire. It is illegal to knowingly make false statements on this form. If eligible, students are to be immediately enrolled in accordance with Bulletin 741, section 341.

Did the student receive McKinney Vento (Homeless) Services in a previous school district? Yes No
Is the student’s address a temporary living arrangement? Yes No
(Note: If this is a permanent living arrangement or the family owns or rents their home, sign under item 9 and submit form to school personnel.)
Is the temporary living arrangement due to loss of housing or economic hardship? Yes No
Does the student have a disability or receive any special education-related services? (Check one) Yes No
Where is the student currently living? (Check all that apply.)
In an emergency/transitional shelter.

Temporarily with another family because we cannot afford or find affordable housing.

With an adult that is not a parent or legal guardian, or alone without an adult.

In a vehicle of any kind, trailer park or campground without running water/electricity, abandoned building or substandard housing.

Emergency Housing (i.e. FEMA Trailer or FEMA Rental Assistance)

In a hotel/motel.

Other specific information:
Does the student exhibit any behaviors that may interfere with his or her academic performance? Yes No
Would you like assistance with uniforms, student records, school supplies, transportation, other?
(Describe):
Migrant – Have you moved at any time during the past three (3) years to seek temporary or seasonal work in agriculture (including Poultry processing, dairy, nursery, and timber) or fishing? Yes No
Does the student have siblings (brothers or sisters)? Note: Use back of page if more space is needed. Yes No

Name School Grade DOB

Name School Grade DOB

Name School Grade DOB
The undersigned certifies that the information provided above is accurate.

If the student is Homeless

If they are in Foster Care

Additional Information

Do you receive MEDICAID/SNAP Benefits?

Upload Proof (Insurance card or eligibility letter) Optional during application. Required for registration.

Special Education Services (IEP/504):

Yes

English as a Second Language (ESL):

Yes

Free/Reduced Lunch:

Yes

Medical Conditions/Allergies:

Required Documents

Documents can be attached on the site and uploaded or emailed to enrollment@graderesults.com or faxed to 866.937.8871,info@clarksburgvirtual.com or mailed to Grade Results at 1316 Newport Dr., Carrollton, TX 75006.

Birth Certificate

Proof of Residence

Proof of Immunization and Health Screenings

Prior Academic Records

IEP/504 Documentation

Transcript Documentation

Other Documents for Special Circumstances

Custody order, Gifted documentation, Special Education Documentation: IEP Documentation: Supporting Evaluation Documentation, IEP Exit Documentation, 504 Plan

Utility Bill

Rent Agreement

Driver License

State-Issued ID

Select Document

Note: Proof of Residency and Proof of Age (Driver's License or State-Issued ID are both mandatory)

Chromebook

Will you be needing a chromebook?

Yes

To be filled by Parent/Guardian

What are your plans post-secondary?

There are no assurances upon earning a diploma from the receiving school that the graduate will meet admission requirements of any post-secondary educational entity or military branch. Please review the admission requirements of your intended post-secondary entity or military branch before moving forward. Your signature below indicates that you understand these requirements and agree to move forward

Student Signature

Clear

Parent Signature

Clear

By clicking "Submit", you agree to Grade Results' Terms of Use and Privacy Policy. You consent to receive phone calls and SMS messages from Grade Results to provide updates on your application.

Student Enrollment Form

Student Information

Academic Information

Parent or Guardian Information

Parent or Guardian Information 2 / Additional Contact

Migrant Education Program Occupational Survey

Student Residency and Military Affiliation Survey

DPS&C Reporter Information

Parole/Probation Officer / Parent Information

References

Interests

Primary/Home Language Survey for All New Incoming Students

Questions for Parents or Guardians

Louisiana Student Residency Questionnaire

IEP/504 Section

Disability Information

Supporting Documentation (check all that apply)

Additional Information

Required Documents

Available Courses

Chromebook

To be filled by Parent/Guardian

Student Signature

Parent Signature

Student Enrollment Form

Student Information

Academic Information

Parent or Guardian Information

Parent or Guardian Information 2 / Additional Contact Add Parent

Migrant Education Program Occupational Survey

Student Residency and Military Affiliation Survey

DPS&C Reporter Information

Parole/Probation Officer / Parent Information

References

Interests

Primary/Home Language Survey for All New Incoming Students

Questions for Parents or Guardians

Louisiana Student Residency Questionnaire

IEP/504 Section

Disability Information

Supporting Documentation (check all that apply)

Additional Information

Required Documents

Available Courses

Chromebook

To be filled by Parent/Guardian

Student Signature

Parent Signature

Parent or Guardian Information 2 / Additional Contact