Admissions Inquiry Form

	Contact Name*

	Relation to Student: *

	Date*

	Student's Name *

	Current Grade Level*

Interested in applying for following school year: *

2010-2011

	Date of Birth *

	Age *

	Parent/Guardian #1 *

	Parent/Guardian #2

	Parent/Guardian Mailing Address (include city/state/zip) *

	Home Phone Number*

	Business Phone Number

	Cell Phone Number

	Email address *

	Student Lives With*

	Current School Attending*

	District of Resident*

How did you hear about The Carver Academy *

	Relative/Friend
	Advertisement (TV, Radio, publication)
	Current Student
	Other:

Please Note: Questions marked with an asterisk (*) are required.