Student Information:

First Name
Middle Name
Last Name
Date of Birth
Ethnicity/Race Ethnicity: Hispanic / Latino
Race: White
Race: African American
Race: Asian
Race: Native American
Race: Pacific Islander / Hawaiian
Zip Code
Home Phone#
Other Phone#  Describe
Grade Applied For
Current School (Private schools listed at the end of the list)
Does the applicant have a sibling who's attending this school or other LISA ACADEMY campuses?
Does the student have any documented history of a criminal offense or juvenile court adjudication?
If yes, please explain:

Parent/Guardian Information:

First Name
Last Name

We/I, the undersigned, hereby certify that, to the best of our/my knowledge and belief, the answers to the foregoing questions and statements made by us/me in this application are complete and accurate. We/I understand that any false information, omissions, or misrepresentations of facts may result in rejection of this application or future dismissal of the applicant.

NON-DISCRIMINATION STATEMENT: It is the policy of LISA Academy to comply with all state and federal regulations regarding admission and not to discriminate during the admission and the lottery process on the basis of gender, national origin, ethnicity, religion, disability, academic, artistic, athletic ability, or the district the child would otherwise attend.