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Global Outreach Charter Academy Pre-Admission Application For 2010-2011 School Year

Student Information
Student's First Name:
Student's Last Name:
Your Name:
Phone Number:
>
Your Relationship to Applicant:
Zip:
Email:
Applicant Demographic Information
Current School:
Applying For Grade
Has applicant ever skipped grade?:
Yes
No
If Yes, what grade
Is the applicant currently under expulsion?:
Yes
No
If yes, please explain
Gender:
Male
Female
   
Race
Asian
Caucasian
Native Indian/Alaskan
 
Hispanic
African-American
Other
 
Has the student received services in the following programs?
ESOL: Yes
No
If Yes, Language
Special Education: Yes  
No
If Yes, area
Talented and Gifted:
Yes
No
If Yes, Subject
How did you hear about GOCA?
I hereby certify that, to the best of my knowledge and belief, the answers to the foregoing questions and statements made by me in this application are complete and accurate. I understand that any false information, omissions, or misrepresentations of facts may result in rejection of this application or future dismissal of the applicant. I also understand that GOCA will contact me for future communication.
I accept terms and conditions explained above

This is only pre enrollment questionnaire.

Please contact Ms. Golubeva by calling 904-551-7096 or email kgolubeva@gocacademy.com to schedule an appointment and complete enrollment application.