Clara B. Ford and Vista Meadows Academies
20651 West Warren
Dearborn Heights, MI 48127
313-240-4347
villageofhopehs.com
Date Received
STUDENT ENROLLMENT APPLICATION
Student Information
Last Name:
First:
Middle
Home Address:
Home Phone (
Date of Birth
City:
)
Daytime Phone: (
Zip:
)
Cell: (
)
Gender:
Male
Female
Parents/Guardians
Mother/Guardian Name:
email:
Father/Guardian Name:
email:
Mailing Address (if different from above)
If applicable, who is the custodial parent?
School District of Residence:
City:
Educational History
9
What year are you seeking enrollment for? Fall of
10
11
What grade are you seeking enrollment for? Circle one:
12
Do you have a child/children currently enrolled at the Academy?
Yes
No
Has your child ever received special education services?
Yes
No
Has your child ever received academically gifted services?
Yes
No
Yes
No
If “Yes,” what grade?
If “Yes” for either, please describe?
Has your child ever received an in-school detention?
If yes, how many times?
When did the detention(s) occur?
Has your child ever received a suspension from school?
If yes, how many times?
Yes
No
When did the suspension(s) occur?
Has your child ever been expelled from school?
Yes
No
Siblings
(Please list all siblings who are also applying for enrollment to the Academy) This section is to ensure sibling status if one of your
children is accepted. Each child applying must complete a separate Student Enrollment Application.
Last Name
1.
2.
3.
First Name
Class
Last Name
4.
5.
6.
First Name
Class
I understand that by completing and signing this form that my child will be considered for enrollment in the Academy. I further understand that this process does not
automatically guarantee enrollment in the Academy, and that my child’s name may be placed in a lottery for enrollment purposes.
Signed:
Relationship to Student:
Date: