HOLLY ACADEMY

                                 A PUBLIC  SCHOOL ACADEMY              

                                     ENROLLMENT APPLICATION            

 

Name______________________________________________________________Age_____Sex____

          Last                                                     First                                     Middle

Address____________________________________________________________Birthdate________

              Number                                         Street

__________________________________________________________Telephone_______________City                                             State                              Zip                                Area Code & Number

 

Student Social Security Number__________________________________

School Last Attended __________________________________________

                                                              Name                   City, State

School District where you live: __________________________________

How did you hear about the Academy (newspaper, friend, etc.): ______________________

Grade for Which Student is Enrolling at Holly Academy______________

Does Your Child Have Special Needs?         Yes____________ No____________________

Does Your Child Have a Current I.E.P. (Only pertains to Special Education Students)      

                                                                        Yes____________ No____________________

Has your Child ever been suspended or expelled from another school district    Yes ____    No ____

Family Data

                                   Father                                                       Mother

Name of Parent(s)______________________    ____________________________

Occupation/Education __________________     ____________________________

Employer/Phone_______________________    Employer/Phone_______________  

Emergency Contact ____________________    Emergency Phone _______________

 

With Whom Does This Child Reside

Parents______ Stepfather_______ Stepmother _______     Guardian_____ Name of Guardian_______

Other________ Name______________________ Relationship___________

 

NAME OF SIBLINGS ENROLLING/ATTENDING HOLLY ACADEMY

OTHER SIBLINGS IN FAMILY                                  SIBLINGS ATTENDING HOLLY ACADEMY

_______________________AGE                                      _____________________GRADE________

_______________________AGE                                    _____________________GRADE________

_______________________AGE                                    _____________________GRADE________

 

 

ETHNIC DATA (FOR STATISTICAL PURPOSES ONLY)

PLEASE CHECK THE APPROPRIATE CATEGORY FOR YOUR CHILD

______ American Indian or Alaskan Native:  A person having origins in any of the original peoples of North America and

             who maintains cultural identification through tribal affiliation or community recognition.

______ Asian of Pacific Islander:  A person having origins in any of the original peoples of the Far East, Southeast Asia, the

             Indian sub-continent, or the Pacific Islands.  The area includes, for example, China, Japan, Korea, and the Philippine

             Islands, and Samoa.

______Black, not of  Hispanic Origin:  A person having origins in any of the Black racial groups of Africa.

______Hispanic:  A person of Mexican, Puerto Rican, Cuban, Central of South American or other Spanish Culture or origin,

            regardless of race.

______White, not of  Hispanic Origin:  A person having origins in any of the original peoples of Europe, North Africa or

             the Middle East.

______Eastern Indian:  A person having origins in India.

 

________________________________________________________________                            DATE:_____________________________

SIGNATURE OF PARENT OR GUARDIAN OF REGISTERING CHILD

    

FOR OFFICE USE ONLY:

RECEIVED BIRTH CERTIFICATE___________ENROLLMENT DATE______________

RECEIVED IMMUNIZATION FORM_________DATE OF DISCHARGE_____________

820 ACADEMY ROAD, HOLLY, MICHIGAN, 48442 (248) 634-5554, FAX (248) 634-5564

 

 

 

Holly Academy, A Public School Academy

Text Box: HOLLY ACADEMY OFFERS YOU AND YOUR CHILD: • Experienced State Certified Teachers • A Tuition Free Education • Approximate Class size of 25 Students • Spanish at all grades • Full-day developmentally appropriate Kindergarten • Science everyday with certified Science Teachers • A fully equipped Science lab • Desktop and wireless laptop computer labs • Grade appropriate Computer Teachers • Auditorium that seats 425 • Electives for 7th & 8th grade students • Full size hardwood Basketball Court & Gymnasium • Volleyball, Basketball, Cheerleading and Soccer • Before and after school Latch Key Program MISSION STATEMENT “To achieve individual academic success through a positive family, school and community partnership” Holly Academy does not discriminate on the basis of race, color, religion, national or ethnic origin, disability or sex. VISION STATEMENT • To provide the highest quality academic curriculum and learning environment to produce the next generation of educated adults. • Partnership with Collegiate Sponsor • K-8 College Prep • Look and feel of a private school • Strong parental commitment and involvement • School community totally committed to our vision of excellence • Student performance exceeds State Standards in all curricular areas • Campus environment structured to facilitate our curriculum