Student Name *

First Name

Last Name

Current Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Custodial

Yes

No

Custodial

Yes

No

Parents Completed High School *

Both

One

Neither

Parents Attended College *

Both

One

Neither

Marital Status *

Married

Divorced

Separated

Never Married

Student's Cell Phone Number

(###)

###

####

Student Date of Birth *

MM

DD

YYYY

Gender *

Male

Female

Type of Enrollment Being Requested *

Full Time Student (College Prep Program)

Home School Collective - full nurture and up to 4 additional classes

Home School Support - limited nurture; secondary enrollment for online students

Type of Admission

Traditional Admission: Student is matriculating from a school (public or non-connected private school) where 8th grade has been completed and the natural next step is a new institution

Home School Admission: Student is transitioning from a traditional home school setting

African Centered Matriculation: Student is matriculating from an identified African Centered Program. [Children of The Most High, Imhotep Academy, Kilombo Pan-African Institute]

Transfer Student

School Phone Number

(###)

###

####

Start Date *

MM

DD

YYYY

End Date *

MM

DD

YYYY

Current Enrollment Status

8th Grade Graduate/Candidate

Withdrawn

Dual Enrollment Candidate

Home Schooled

Is your family free of any financial obligations to a previous institution? *

Yes

No

Has student been cleared of any conduct or discipline issues at previous institutions? *

Yes

No

Is student currently in good standing with all previous institutions? *

Yes

No

Academic Designation(s): *

All

IEP

IDEA

504 Plan

Talented /Gifted (Student will be tested)

Behavioral STP

None

I (Parent) give TSK Prep the right to contact all previous educational institutions listed on this application for the purposes of creating an academic profile for my child. *

I Agree

I Disagree

I am aware that T.S.K. Prep is a drug free enviornment. I give permission for my child to be tested prior to admission, and on a random basis as seen fit by the administrative staff. I am aware that any illegal substances found in his or her blood stream does not mean immediate denial of admission or expulsion but will be addressed as a major concern of this academic community. *USERS MUST BE IN A TREATMENT PROGRAM * *

I Agree

I Disagree

Learning Coach is a custodial parent? *

Yes

No

Thank you for your interest in Tamu Sana Kanyama Preparatory Academy High School Program or Nurture Program for S.W.AT.L. Home School Connection. We look forward to meeting with you and your family. Someone from our staff will be contacting the parent listed as #1 to schedule an interview and admission test.

I understand that this is not an offer of admission and that by completing this application I am requesting admission to this institution with knowledge of tuition costs and attendance requirements.