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ACADEMY OF WARREN
13943 E. 8 Mile Road * Warren, MI 48089 * Phone: 586-552-8010 * Fax: 586-552-4749
web: academyofwarren.net
Mr. Justin Hauser, Director of Student Development Mr. Oronde Kearney, Chief Academic Officer
RE-ENROLLMENT FORM 2019-2020 SCHOOL YEAR
*Please complete
only
if your child was an active student on 6/15/2019.
Only one form per student, please.
Yes!
I would like for my child to return to the Academy in the Fall of 2019.
Student's Last Name:
*
Student's First Name:
*
Grade Level (September):
*
Student's Home Address:
*
City:
*
State:
*
Zip Code
*
Student's Home Phone:
*
Student lives with:
*
Both parents (same household)
Joint custody
One parent (name)
One parent (name)
I understand that completing this form does not guarantee my child's acceptance into Academy of Warren for the Fall of 2019. I further understand that my application will be processed in the order received and that all openings are filled on a first-come, first-served basis.
Parent/Guardian Signature (use mouse or finger with trackpads and touchscreens)
*
clear
Today's Date
*
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