Pre-Enroll Online Now! (2017)

Pre-Enroll Online Now!

Enrollment Policies

Pre-Enrollment Form (2017-2018)

Student Info

* Indicates required field

Last Name *

First Name *

Middle Name *

Home Phone (or best cell) *

Address (Number and Street) *

City *

State *

Zip Code *

Grade for 2017-18 school year *

Birth date (mm/dd/yyyy) *

Social Security Number *

Ethnicity/Race *

Does your child currently receive any special education services or have an IEP? *

NO YES

Father Info

Name *

Daytime Phone Number *

Evening Phone Number *

Employer *

Mother Info

Name *

Daytime Phone Number *

Evening Phone Number *

Employer *

Step Parent or Guardian Info

Name *

Daytime Phone Number *

Evening Phone Number *

Employer *

Guardianship *

School District in which Parent/Guardian Lives *

Parent/Guardian Email Address *

Name of Last School Child Attended *

If child not English profficient, language spoken. *

By typing my full name here, I affirm that this form is filled out accurately to the best of my knowledge. *

Submit

After you click "submit," please wait to be redirected to the confirmation page. It may take several seconds. If you are not redirected, scroll up and look for any fields highlighted in red that need to be adjusted. If you have any problems submitting this form, you can just alert us with a quick note on the Contact Us page or call 260-579-6939. Thank you.

Dear Parent/Guardian,
Thank you for pre-enrolling at Smith Academy for Excellence. We are pleased to offer a high quality, unique, tuition free education for your child. We look forward to working with you and your child.
Sincerely,
Corey Smith
School Leader