Zenith Academy West – Zenith Academy

Student Name

First

Middle

Last

Date of Birth

Email

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Emergency Contact 1:

Name

First

Last

Relationship to Applicant

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Emergency Contact 2:

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Address the School

Relationship to Applicant

Phone Number

Universities that are recipients of federal dollars are required by the Federal government to solicit certain demographic information to meet federal reporting requirements. Applications are requested to provide the following information voluntarily. This information will not be utilized in a discriminatory manner.

Nation of Citizenship

Race / Origin

Native Language

Gender

Enrollment Grade?

If your records have been expunged pursuant to applicable law, you are not required to answer yes to the following questions. If you are unsure whether to answer yes, we strongly suggest that you answer yes and fully disclose all incidents to avoid any risk of disciplinary action or revocation of your offer of admission.

Previous School Information

School Name

School Address

Address Line 1

Address Line 2

City

State

Zip Code

Please provide the names of people in your immediate family who have attended the University.

Parent/Guardian Information

Parent 1 Name

First

Last

Relationship

Parent 2 Name

First

Last

Relationship

Does the student have an IEP?

Yes
No

Proof of ID