Enrollment Application We are currently enrolling! Oakland Academy Enrollment Form Applying For:(Required) Month: Year Grade for Fall:(Required)K12345678School Type(Required) Traditional In-Person Virtual Learning / Oakland Bridge Program Student Information:(Required) Last First Middle Date of Birth(Required) Month Day Year Birth Place (city)(Required)Gender(Required) M F Twin/Triplet? Yes No Student Primary Residence(Required) Street Address Address Line 2 City State ZIP / Postal Code Home PhoneSchool District of Residence(Required)Previous School Attended(Required)Did your child attend Preschool?(Required) Yes No If yes, give name of programETHNICITY INFORMATION (PER MI DEPT of ED): American Indian/Alaska Native Black/African Asian American Native Hawaiian/Pacific Islander Hispanic/Latino White N/A Parent/Guardian InformationName(Required)Relationship to Student(Required)Legal Guardian?(Required) Yes No Address (If Different from Student's Address) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Home PhoneCell Phone(Required)Work PhoneExtEmail(Required) Employer/OccupationNameRelationship to StudentLegal Guardian? Yes No Address (If Different from Student's Address) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Home PhoneCell PhoneWork PhoneExtEmail Employer/OccupationMedical InformationPlease list all special medical needs and current medication:Has student had chicken pox?(Required) Yes No DateSpecial ServicesDoes student have an Individual Education Plan?(Required) Yes No DateDoes student have a 504 Plan?(Required) Yes No DateDid student receive Special Services at previous School?(Required) Yes No Circle Services Received Speech Social Work L.D. E.C.D.D. E.L. V.I. H.I. P.I. A.I. O.H.I. T.B.I. C.I. E.S.L. Resource Room Self Contained Classroom Title I Home LanguageIs the student's primary language English?(Required) Yes No if no, language spoken:Is the parent's primary language something other than English?(Required) Yes No if yes, language spoken:Has the student received English Language Service Support?(Required) Yes No Temporary Living ArrangementsThese questions cover the definition of homeless that is within the No Child Left Behind Law. This enrollment form will meet the MSIP Standard 8.3.1 for enrollment identification.Are you sharing the housing of others due to loss of housing, hardship or a similar reason? Yes No Explain if it is a similar reason:Are you currently residing at a motel, hotel, car or campsite because your home has been damaged or for economic reasons? Yes No Are you currently residing in a shelter? Yes No Are you currently living in a temporary housing arrangement due to economic hardship? Yes No SiblingsDoes this student have sibling(s) currently enrolled at Oakland? Yes No Name(s)Does this student have siblings also applying at Oakland Academy?(Required) Yes No Name(s) & Grade(s)Has your student ever been suspended or expelled? If yes please explain... Yes No Please Explain:Oakland AcademyHow did you find out about Oakland Academy? If refered by an individual, please include their name.Why do you want your child to attend Oakland Academy?(Required)*It is the parent's responsibility to notify the school of address or phone number changes.Please note: In order for a child's application to be considered for the school year during open enrollment ends, parents will be officially notified by mail of their child's enrollment. Openings that occur AFTER the official notification process has been completed will be filled on a first-come, first-serve basis. After receiving the official notification of their child's acceptance in Oakland Academy, parents are expected to sign a Release of Records form, and to send it back to the Academy with a copy of the child's birth certificate and most recent immunization records, If there are any questions about this process, parents are encouraged to contact Oakland Academy at (269) 324-8951. Thank you for your interest in Oakland Academy!Signature(Required)Today's Date(Required) MM slash DD slash YYYY CAPTCHA
