Merit Academy Student Application Form

First Name*
Last Name*
Street Address*
City*
State*
Zip*
Email*
Phone*
Birthday*
Please list sibling name(s) and age(s) (if any)
If the student does not live with both parents, please describe their living situation (joint custody schedule, etc.)

If the student has special needs (physical, emotional or developmental), please describe

In the fields below, list the range(s) of time the student is NOT available due to school or other activities.
Example: 8am-3pm / 4pm-7pm. If they are open all day, write “Open”.

Monday Schedule*
Tuesday Schedule*
Wednesday Schedule*
Thursday Schedule*
Friday Schedule*
Saturday Schedule*
Sunday Schedule*
If this schedule will change, enter the last date it will be valid*:

Name of School Student Attends*
Academic Year/Grade* (2020-2021; 9th grade)
Student’s Current GPA*
Name of Student’s Guidance Counselor
Why are you enrolling your child at Merit Academy?

Is there anything else we should know about the student?*