Prospective Student Form – Little Light Christian School

Prospective Student
Form

Caregiver's Name*
First Last
Email Address*
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Student's Name
First Last
Age of Student*
Current Grade Level*
School Currently Attending*
Is your student having problems in school?*
- Yes
- No
Please Explain*
Does the student have a parent who is or has ever been incarcerated?*
- Yes
- No
Please provide information (who is incarcerated, name of correctional facility, length of incarceration, dates, etc).*
Is there anything else you would like for us to know about your student?
Who referred you to Little Light Christian School?
Would you preferred to pickup a packet or have one emailed to you?*
- Pickup
- Emailed