Enrollment - Nelson Academy

Student Information

First Name

Middle Name

Last Name

Gender

Date of Birth

Place of Birth

Race

Verify Email

Phone

Social Security #

Driver's Licence

Address

City

State

Zip

Academic Information

Last Grade Completed

Last School

Do you have an IEP (Individualized Education Plan)?

County / Parish Name

Student ID#

Location / City

State

Parent or Guardian Information

First Name

Last Name

Suffix

Phone

Address same as student

Address

City

State

Zip

Parent or Guardian Information 2 / Additional Contact

First Name

Last Name

Suffix

Phone

Address same as student

Address

City

State

Zip

DPS&C Reporter Information

Name

Phone

Parole/Probation Officer / Parent Information

Name

Phone

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.

Required Documents

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

Birth Certificate

Social Security Card

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

Select Document

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

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Disclaimer: By providing my contact information to Grade Results, I acknowledge and give my explicit consent to be contacted via SMS and receive emails for application process.

Student Enrollment Form

Student Information

Academic Information

Parent or Guardian Information

Parent or Guardian Information 2 / Additional Contact

DPS&C Reporter Information

Parole/Probation Officer / Parent Information

Interests

Primary/Home Language Survey for All New Incoming Students

Questions for Parents or Guardians

Louisiana Student Residency Questionnaire

Required Documents

Available Courses

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

DPS&C Reporter Information

Parole/Probation Officer / Parent Information

Interests

Primary/Home Language Survey for All New Incoming Students

Questions for Parents or Guardians

Louisiana Student Residency Questionnaire

Required Documents

Available Courses

To be filled by Parent/Guardian

Student Signature

Parent Signature

Parent or Guardian Information 2 / Additional Contact