REACH ACADEMY FOR GIRLS CHARTER SCHOOL
3210 Philadelphia Pike, Claymont DE 19702
Student Application

Please fill out the application below for each girl you apply for. We are now accepting applications for grades K, 1, 5 & 6. First Year enrollment will be limited to four initial class grades with additional classes added each year. Please fax to 1-888-302-6535 (this number is for voice and fax messages) or mail to the above address Attn: Student Enrollment.

Student Information:

Daughter’s Name: First_____________________________ Last_______________________________

Date of Birth: _____________________________ (include year)

Address: _____________________________________________________________________________

City: ______________________________________ State: _______________ Zip: __________________

Present School: ______________________________________________________

Daughter’s grade in fall of 2010_____________________

Public School District in which the student resides: (not necessarily where the student attends school)

________________________________________________

Please provide parent/guardian Contact information:

First: __________________________________ Last: __________________________________________

Address: ______________________________________________________________________________

City: ______________________________________ State: _______________ Zip: __________________

Work Phone ( ) ___________________ Home Phone ( ) _____________________________

Email address: _____________________________________________________

Are you applying for additional siblings?

Sibling 1 Name ____________________________________________

Date of Birth _____________________________________________

Sibling 2 Name ____________________________________________

Date of Birth _____________________________________________

Students will be requested to provide proof of residency and other school records in order to register for Reach Academy. This is a pre-enrollment application and does not guarantee acceptance into the program. Parents will be contacted for a registration interview to complete the registration process.

Reach Academy for Girls does not discriminate race, culture, physical ability or religion.