Microschool Admissions Application

General Information
Student Full Name*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Date of Birth*
MM
DD
YYYY
Gender*
Current Grade*
Gifted and/or Special Needs*
Does this child qualify for gifted or special needs services through the school district? Check all that apply below.
- No
- Gifted
- ADD/ADHD
- Anxiety
- Autism
- Dyslexia
- Other
- Check this box if your child qualifies for an IEP or 504 plan through the school district.
Parent/Guardian
Full Name*
First Last
Relation to Applicant*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Parent/Guardian Email*
Work Phone
Cell Phone*
Parent/Guardian
Full Name
First Last
Relation to Applicant
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Parent/Guardian Email
Work Phone
Cell Phone
Marital Status*
What languages are spoken at home and by whom?*

Parent Perspective
Waybright Academy is a modern learning environment. What in your child's academic or personal life leads you to consider him/her likely to respond well to the modern learning environment Waybright presents? What gives you pause as to your child's academic and personal readiness for Waybright Academy?*
Describe what you, as a parent/guardian, are looking for in a school. Include information about the kinds of courses, classroom experiences and the overall education plan you would most like to see for your child.*

Student Perspective
(to be completed by the student)
Describe your personality, include information about how you get along with others; how you feel about yourself, what you think is important in life, and how you think others tend to see you.*
Describe your academic strengths and weaknesses. Include information about your work ethic and attitude toward school and learning in general. Include ideas you have about your future academic and/or career plans.*
In your decision to apply for acceptance to Waybright Academy, what are you seeking (order by importance, 1 being most important)?
Social/Peer Connections*
Academic Challenge*
Non-Traditional Learning Environment*
Other (please list)

Schooling History
Most Recent School
School Name*
School Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Type*
Gifted Program and/or Acceleration*
- Yes
- No
Grade Levels Attended*
If partially accelerated, indicate subject(s)
If fully accelerated, indicate grade levels skipped
Previous School
(if applicable)
School Name
School Address
Street Address City State / Province / Region ZIP / Postal Code Country
Type
Gifted Program and/or Acceleration
- Yes
- No
Grade Levels Attended
If partially accelerated, indicate subject(s)
If fully accelerated, indicate grade levels skipped

Additional Required Details
Has your child ever been disciplined (including, but not limited to, suspended or expelled) for any action or inaction that requires discipline under the laws or regulations of your state?*
- Yes
- No
If yes, please explain.
Has your child ever exhibited harmful behaviors toward himself/herself or others, or threatened violence to himself/herself or others, of which we should be aware of in formulating an educational program?*
- Yes
- No
If yes, please explain.

Attestation and Electronic Signatures
I/We attest that to the best of my/our knowledge, all information included in this application and any/all attachments are accurate and true. I/We understand that detection of omitted or falsified information may result in terminating application review or revoking acceptance and/or enrollment.*
Type your name in the box to confirm you have read and agreed to this attestation.
Signature (Parent/Guardian #1)
Date*
Date Format: MM slash DD slash YYYY
Signature (Parent/Guardian #2)
Date
Date Format: MM slash DD slash YYYY
Credit Card

Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Application Fee
Price: $50.00

WAYBRIGHT ACADEMY