This Preregistration form is for New Students only.

Reenrollment for current students will be open February 1st, 2019.

Student Information
Legal Name from Birth Certificate
**Legal Name: **First: Middle: **Last:
**Date of Birth: MM/DD/YYYY
Preferred First Name:
**Previous School:
Enter NONE in all three boxes
if Kindergarten student
School Name:
**Grade Level: Next Year's Grade Level
**Anticipated Start Date:
Current Special Programs IEP 504 ELL Speech Therapy
**Attended before Has this student ever attended American Leadership Academy before?
**Applied before Has this student ever applied to American Leadership Academy before?
**Kindergarten Is this student registering for full-time or half-time kindergarten?
**ALA Employee Does the parent or guardian of this student work for American Leadership Academy?
Employee Name If Yes above, please enter the employee name.
**Multiple Family Members
**Birth Certificate I will provide a copy of my child's certified birth certificate or other form of reliable verification of the child's identity and age, current immunization record, and IEP/504 (if applicable) to the school. I understand not completing this step will make my child ineligible to attend ALA and my spot may be given to another applicant.

Disclaimer: State law required that a form of identification and a current immunization record must be on file in order to attend school. As custodial parent/legal guardian of this student I verify that the information provided to the best of my knowledge is true and correct. I also understand that misrepresentation of ANY information may result in this student being removed from school permanently or until the issue is resolved.
By typing your name here you are agreeing to the terms of the disclaimer.

Policy: It is the policy of American Leadership Academy not to discriminate on the basis of sex, race, color, national origin, religion, disabilities or any other legally protected class.
Parent/Guardian Information
**First Name: **Last Name:
**Relationship to Student:
Other Students in Family: Check this box if other members of your family are active students at our schools
**Desired User Name: Desired User Name for PowerSchool Login
**Phone: 999-999-9999      Alternate Phone: 999-999-9999
**Zip Code:
**Verification: I verify that the above information is correct
** Required Information