3211 Bramer Drive, Raleigh, NC 27604 // Phone: (919) 850-9960 Fax: (919) 850-9961

Student Enrollment Application

Student's First Name *

Student's Middle Name

Student's Last Name *

Student's Home Address *

City, State *

Zip Code *

Date of Birth *

Student's Gender

MaleFemale

Student's current age *

What is the Name of the current school your child is attending? *

Student's grade this school year 2015-2016 *

Grade applying for school year 2016-2017 *

Father's First and Last Name *

Father's home phone number *

Father's cell phone number *

Mother's First and Last Name *

Mother's cell phone number *

Mother's home phone number *

Parent/Guardian email address *

With whom does student currently live? *

What language is most often spoken in your home? *

Was your child enrolled in special education program in his/her previous school?

YesNo

Does your child have an I.E.P.

YesNo

Was your child ever suspended (or exepelled) from his/her previous school?

YesNo

Was your child in a self-contained special education classroom last year or does your child need one this year

YesNo

I will drive my child(ren) to/from school

YesNo

I will drive my child(ren) to ride the school bus

YesNo

Does your child have any medical or physical disabilities?
if yes please discribe

By submitting this form, I certify that all of the above information is accurate. I give Torchlight permission to request information about my child from his current/former schools. I understand that Torchlight Academy can deny or revoke admission or enrollment if any information is found to be incomplete or inaccurate. *