K-8th Grade

White Pine Academy
Application For Admission (K-8th Grade)

Student Information

* Indicates required field

Name *

First

Last

Grade Level Applying For *

Present Grade Level *

Age *

Date of Birth *

Place of Birth *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone Number *

Emergency Contact Person *

Emergency Phone Number *

Email *

Immunizations Up to Date *

Yes No

Has the student ever been suspended from school? *

Yes No

Has the student ever been expelled? *

Yes No

If you replied "yes" to either question, please explain below: *

Does the student receive Special Education services or have an IEP? *

Yes No

If you replied "yes" please provide details below: *

Parent/Guardian Information

Father/Guardian's Name *

First

Last

Present Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Mother/Guardian's Name *

First

Last

Present Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

If you affirm the above information to be true and accurate Initial and Dare the lines below.

Initial *

Date *

Submit

Prefer a paper copy? Download one below:
K-8 Application for Admission

Principal: Marianne Dege
Phone: 517-589-8961
Fax: 517-589-9194
510 Russell Street, Leslie, MI 49251

White Pine AcademyApplication For Admission (K-8th Grade)

Student Information

Parent/Guardian Information

White Pine Academy
Application For Admission (K-8th Grade)