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“The direction in which education starts a man will determine his future in life.”

Plato

Enrollment Interest Form

Please complete the interest form and a team member will be in touch with you shortly.

Apllicant Name

Guardian/Legal Rep. Full Name

Applicant DOB

Email

Phone

Schedule Interested in

Prerred Start Date

Select an option

Allergic to Nuts

Allergic to Dairy

Allergic to Shellfish

I Certify that applicant:

IS independent with toileting & hygiene (does not require assistance)

IS able to handle reasonably crowded or stimulating environments on campus and in the community

IS able to transition throughout the day

Is NOT aggressive physically or verbally, and/or a danger to themselves or others

Is NOT an elopement risk (risk of running away)

Does NOT require one on one assitance

Is NOT Medically Fragile (We do not have nursing staff or medical staff onsite)

I ackolwedge the inormation above is true and accurate.

Thanks for submitting!

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