Student Application

STUDENT INFORMATION

Date
Grade Entering 2009-10

First Name
Middle Name
Last Name

Gender
Birth Date (month/day/year)
Nickname

City
State Zipcode
Telephone Number

Social Security #
Language(s) Spoken at Home
Ethnicity

Current School
School District
Current Grade Level
FAMILY INFORMATION
Parent/Guardian #1

First Name 
Last Name
Relationship to Student

Street Address, Apt. #
City     
State Zipcode

Home Telephone
Work Telephone
Cell Phone/Other

Email Address  
Preferred Method of Communication
Parent/Guardian #2

First Name 
Last Name
Relationship to Student

Street Address, Apt. #
City     
State Zipcode

Home Telephone
Work Telephone
Cell Phone/Other

Email Address  
Preferred Method of Communication
BACKGROUND INFORMATION
Your answers to these questions do not affect your child’s admissions to AXL.  The information will be used to improve our planning and marketing efforts and will be kept confidential.

Why do you think AXL will be a good fit for you child and your family? (check all that apply)
Public Charter School

Expeditionary Learning

Longer School Day/Year
College Preparatory Second Language Program Location of School
Single Sex Instruction Diversity of School Other

How did you hear about AXL?

AXL Website

 Preschool/Head Start Community Bulletin Board/Flyer in Store
Direct Mail Newspaper Other
Friend/Neighbor/Family School District

My child has been participated in: (check all that apply)

Group Preschool

Gifted & Talented

 Free & Reduced Lunch
Head Start English as a Second Language (ESL) Home School
Full-Day Kindergarten Speech & Language Private/Parochial School
Special Education Hearing Other 

Does your family currently meet federal guidelines for free & reduced lunch?
Yes No

Are you interested in before/after school programs for your child?
Yes No

Are you interested in AXL’s preschool program (scheduled to open in 2009-10)?
Yes No

What is your highest level of education?

Some High School

 Associates Degree Masters Degree
High School Graduation Bachelors Degree PhD/Doctorate
Some College