B.O.O.K. Academy Enrollment Form Student Name * First Name Last Name Gender Male Female Gender non binary Race African Ancestry (Black) Asian Ancestry European Ancestry (White) Indigenous Latinx/Hispanic Middle Eastern Other School Name Grade * TK K 1 2 3 4 5 6 7 8 9 10 11 12 My child reads _______ grade level At Above Below Not sure My child's math skills are _______ grade level At Above Below Not Sure Is your child an English Language Learner? Please choose yes if you child is not a fluent English speaker. No Yes Does your child have an IEP of 504 Plan? None IEP 504 My students is interested in Check all that apply. Please note that upon enrollment students have access to all classes offered in their grade level. Homework Help/Tutoring Math and Lit Pods Mental Wellness Pod Something Else Guardian Name * First Name Last Name Guardian Name First Name Last Name Email * Most frequent mode of communication will be email. Phone * (###) ### #### Mailing Address Since we are virtual, certificates, prizes, information and materials may be mailed. Address 1 Address 2 City State/Province Zip/Postal Code Country Please describe any specific learning differences or needs that your child may have. Use this area to share anything else you would like our staff to know about your child. Thank you for enrolling in Destiny Academy! You will receive an email with login credentials for Zoom platform learning. If you are new to Destiny, our staff will reach out to discuss personal goals for your child this semester.
