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
**Gender:
Preferred First Name:
**School:
**Previous School:
Enter NONE in all three boxes
if Kindergarten student
School Name:
City:
State:
**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.
**Signature
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
**Email:
**Phone: 999-999-9999      Alternate Phone: 999-999-9999
**Street:
**City:
**State:
**Zip Code:
**Verification: I verify that the above information is correct
** Required Information