113 West Public Square
270-629-2350
Application for Admission
Name of Student: ________________________________________________________
Date of Birth: ________________________
Current Grade: ________________
Current School: __________________________________________________________
Special Education Services: Y
N
Parent or Guardian: _______________________________________________________
Telephone Number: ______________________________________________________
Please write the reason you would like to attend The Phoenix:
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Please let us know why you believe the typical high school is not for you:
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List the types of careers that you are interested in pursuing:
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Please list your counselor’s name: ___________________________________________
Jill Leftwich
Nicole Jones
Angie Frazier
CheyAnne Fant
Glenn Byrd