ALCA Student Enrollment Form

Student's Legal First Name *

Student's Legal Middle Initial *

Student's Legal Last Name *

Preferred Name *

Name of adult with whom student lives *

Relationship to Student? *

Address *

Address

City

State/Province

Zip/Postal

Student's Home Phone *

Student's Cell Phone

Student's Email Address *

This email address with be used to access the ALCA network

Date of Birth *

Age *

Sex *

Male

Female

Birthplace *

US Citizen *

Yes

No

Grade Entering *

Abeka Accredited *

Yes

No

Semester Beginning *

State Assigned Testing # (if applicable)

Parents of this student are: *

Please select all that apply

Primary Language Spoken in the Home *

English

Spanish

Other

Ethnic Origin: *

Please select all that apply