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Student Application

Life Quest Girls Academy

Student Application

Student Name *

Student Birthday *

Student Current Photo

Parent/Guardian Name 1 *

Parent/Guardian 1 Occupation *

Address *

State *

City *

Postal code *

Phone *

Email *

We require each student be willing to attend voluntarily and give their best effort as a student at Life Quest Girls Academy.

Yes, I understand the importance of this requirement

My daughter is not currently willing to attend Life Quest. I would like someone to contact me with more information about the importance of this requirement.

Most recent grade applicant has completed? *

Current GPA *

Current Extra Curricular Activities *

List your daughters strengths. Please include details. *

Does your daughter currently have an IEP or 504 Plan in place? If so, would you describe the accommodations specified? *

Is your daughter planning on attending college or technical school? *

Not Sure

College/University

Technical School

Other

Please check the box that shows your intention for your daughter's length of stay at Life Quest Girls Academy

Long Term Stay 12-24 Months

Short Term Stay 1-90 days

Transitional Housing (Only for students who are 18 or older)

Do you consider your daughter an elopement risk? If so, please explain. *

Has your daughter ever bullied or been bullied. Please explain. *

Please list any social anxieties, medical conditions, diagnoses, medications, allergies, physical limitations, etc. *

Please describe what your daughter plans to do with her life after she turns 18. Please also include her hobbies, interests, and any service opportunities she may have had. Also please describe why, in your opinion, she would be a great student for Life Quest Girls Academy. *

Name of the person submitting this form? *

I certify that the information provided above is true and correct to the best of my knowledge. *

Yes

No