Great Lakes Academy
46312 Woodward Ave. Pontiac, MI 48342 Phone: 248‑334‑6434 Fax: 248‑334‑6457
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Enrollment Application

For School Year:
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* indicates required field
Student Demographics
Legal Last Name:*
Required Input

Legal First Name:*
Required Input

Legal Middle Name:
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Entering Grade:*
Required Input

Gender:*
Required Input

Birth Date:*
Required Input

Input date as MM/DD/YYYY

Or select date from pop-up calendar
» click arrow to change month -- click year to change year

Country of Citizenship (if not USA):
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Social Security Number:
Required Input

To protect privacy, this is not input online

Ethnicity:*
Required Input

Primary Phone:*
Valid phone number required

Home Address:*
Required Input

Street Address & Apt. Number

City:*
Required Input

Zip Code:*
Valid zip code required


Has this student ever received any of the following services?
IEP:*
Required Input

Individual Education Plan

Speech:*
Required Input

ESL:*
Required Input


Student’s First Language:*
Required Input

Language Spoken at Home:*
Required Input

Does this student have any legal issues that the school needs to be aware of:*

Required Input

If Yes, please explain:*
Required Input

Does this student have any medical issues that should be considered when scheduling classes?*
Required Input

To protect privacy, this is not input online

Previous School Experience
Has this student attended Great Lakes Academy before?*

Required Input

Last School:*
Required Input

Last Grade:*
Required Input

Date Withdrawn:*
Required Input

Input date as MM/DD/YYYY

Or select date from pop-up calendar
» click arrow to change month -- click year to change year

Reason:*
Required Input

Previous School Address (Street):*
Required Input

Previous School City/State/Zip Code:*
Required Input

Is this student currently suspended, expelled, or pending disciplinary action from the previous school?*

Required Input

Has this student ever been expelled from ANY school?*

Required Input


PHOTO RELEASE - Your child may be photographed or videotaped for inclusion in school publications and website, or in newspapers, magazines, articles, or letters relating to school activities
Photo Release*

Required Input


Add another child to this application?
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Legal Last Name:*
Required Input

Legal First Name:*
Required Input

Legal Middle Name:
Invalid Input

Entering Grade:*
Required Input

Birth Date:*
Required Input

Input date as MM/DD/YYYY

Or select date from pop-up calendar
» click arrow to change month -- click year to change year

Add another child to this application?
Invalid Input

Legal Last Name:*
Required Input

Legal First Name:*
Required Input

Legal Middle Name:
Invalid Input

Entering Grade:*
Required Input

Birth Date:*
Required Input

Input date as MM/DD/YYYY

Or select date from pop-up calendar
» click arrow to change month -- click year to change year

Add another child to this application?
Invalid Input

Legal Last Name:*
Required Input

Legal First Name:*
Required Input

Legal Middle Name:
Invalid Input

Entering Grade:*
Required Input

Birth Date:*
Required Input

Input date as MM/DD/YYYY

Or select date from pop-up calendar
» click arrow to change month -- click year to change year

Add another child to this application?
Invalid Input

Legal Last Name:*
Required Input

Legal First Name:*
Required Input

Legal Middle Name:
Invalid Input

Entering Grade:*
Required Input

Birth Date:*
Required Input

Input date as MM/DD/YYYY

Or select date from pop-up calendar
» click arrow to change month -- click year to change year

Parent / Guardian Information
The effect of a sole custody award on authority of other parent (ORS 107.154). Unless otherwise ordered by the court, an order of sole custody to one parent shall not deprive the other parent of the following authority: To inspect and receive school records and to consult with school staff concerning the child's welfare and education, to the same extent as the custodial parent may inspect and receive such records and consult with such staff;
Primary Parent / Guardian 1
Does child reside with you?*

Required Input

Relationship to child:*
Required Input

If Other, what is relationship to child?*
Required Input

Last Name:*
Required Input

First Name:*
Required Input

Middle Initial:
Required Input

Address:*
Required Input

City:*
Required Input

Zip Code:*
Valid zip code required

Provide phone numbers*
Required Input

Home Phone:*
Phone number required

Work Phone:*
Phone number required

Cell Phone:*
Phone number required

Email:*
Must be a valid email address

Secondary Parent / Guardian 2
Is there Secondary Parent / Guardian information?*

Required Input

Does child reside with you?*

Required Input

Relationship to child:*
Required Input

If Other, what is relationship to child?*
Required Input

Last Name:*
Required Input

First Name:*
Required Input

Middle Initial:
Required Input

Address:*
Required Input

City:*
Required Input

Zip Code:*
Valid zip code required

Provide phone numbers*
Required Input

Home Phone:
Phone number required

Work Phone:*
Phone number required

Cell Phone:
Phone number required

Email:*
Must be a valid email address

How did you hear about Great Lakes Academy?
*
Required Input

If Other, how did you hear about us?*
Required Input


You will need to supply additional student information and approvals on the paper copy of the enrollment application at Great Lakes Academy.

This includes:

  • Social Security Number
  • Medical Information
  • Permissions and Authorizations
  • Expulsion Statement
  • Student Transportation Waiver Agreement

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