Enrollment Form For Journey School of Peoria, AZ Please complete this entire online form in order to begin the application process. Thank you. Please enable JavaScript in your browser to complete this form.Student Name *Birth DateGenderMaleMaleFemaleEmail *Phone / Cell Phone *AddressCityState and Zip CodeCurrent SchoolCurrent GradeMedical IssuesMedical NeedsMedication AllergiesOther AllergiesSpecial Dietary NeedsParent 1 NameParent 1 CellularParent 1 House PhoneParent 1 EmailParent 1 Address (if different from child) Parent 1 Business NameParent 1 Business PhoneParent 2 NameParent 2 CellularParent 2 House PhoneParent 2 EmailParent 2 Address (if different from child)Parent 2 OccupationParent 2 Business NameParent 2 Business PhoneLevel of EnglishBeginnerConversationalFluentNativeOther languages spoken Civil status of parentsMarriedMarriedDivorcedSeparatedWidowCivil UnionWho has legal custody of child?Parent 1Parent 1Parent 2BothOther information regarding familiar relationships of the applicant (step-mother, step-father, legal guardian, etc.)Do you as a parent authorize Journey School to communicate with any of your child's previous schools regarding information in this application?YesNoHas the applicant repeated, skipped, or been removed from a grade?YesNoHas the applicant received any form of psycho-pedagogical assessment?If you answered affirmatively in any of the previous two questions please clarify and upload any relevant documentation.Does the applicant require any form of Individualized Education Plan (IEP)?YesNoIf you answered affirmative please clarify and email any relevant informationName and age of applicant's siblingsApplicant Nationality Select the tuition structure that you are applying forFull TuitionFull TuitionFinancial Aid (less than 50% discount - send form)Scholarship (more than 50% discount)Submit
