Little Light Christian School

Prospective Student
Form

Caregiver’s Name(required)

Email Address (required)

Mailing Address (required)

City (required)

State(required)

Zip (required)

Home Phone Number (required)

Student's Name(required)

Age(required)

Current Grade Level(required)

School currently attending(required)

Is your student having problems in school? (required)
YesNo

If yes please explain.

Does the student have a parent who is or has ever been incarcerated?(required)
YesNo

If so 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?