Nelson Academy of Agricultural Sciences Enrollment Form

Student Name (Not Parent)

Student Date of Birth *

Sex *

Male

Female

Race / Ethnicity *

Race / Ethnicity - Other - Please Type

School / Homeschool *

Student Email *

Current Grade Level *

Section 504 *

Yes

No

IEP? *

Yes

No

Course(s) Purchased. *

Starting Date *

Ending Date (20 Weeks from Start Max)

Parent/Guardian Information

First Name *

Last Name *

Address

Street Address *

State *

City *

Zip Code *

Phone *

Registering Parent Email *

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