1

Enrollment Type and Schedule

Enrollment Status *

New Student Returning Student

Program *

Accelerate High School (Grades 5 to 8) - $7,500/year Launch Prep (Grades 3 to 4) - $7,500/year Single Subject (Grades 6 to 12) - $2,000/year Summer Elite (Grades 3 to 12) - $400 Tutoring (Grades K to 12) - $20/half hour

Community Outreach (Free Programs)

Accelerate Intervention - HS Seniors graduation support (FREE) Accelerate Opportunity - Adult 18+ GED/ASVAB/career guidance (FREE)

Grade Level *

Start Term *

2

Student Information

Legal First Name *

Legal Middle Name

Legal Last Name *

Preferred Name

Date of Birth *

Place of Birth *

Sex *

Ethnicity *

Race *

Street Address *

Apt/Unit

City *

State *

ZIP *

Mailing Address (if different)

Proof of Identity

Per Florida Statute 1002.42, private schools must verify student identity and age eligibility for grade placement. Please upload a clear copy of the student's state-issued birth certificate.

Birth Certificate *

3

Funding

4

Previous School

Complete school contact information enables us to prepare your Student Records Transfer Authorization for signature. Per Florida Statute 1002.42(3), private schools must maintain student records including enrollment history.

School Name *

School Type *

School Address *

School ZIP

School City *

School State *

Last Date Attended

School Phone *

School Email *

Fax (if available)

Records Contact Name

Records Contact Email

Records Contact Phone

5

Academic Services

Check any that apply

IEP 504 Plan Gifted Designation ELL Services Other ESE Services

Accommodation Notes

Supporting Documentation (Optional)

Upload IEP, 504 Plan, evaluation, or other relevant documentation. Maximum file size: 5MB.

6

Parents or Guardians

Parent or Guardian 1 is required and will serve as the primary contact for enrollment communications. Signature fields throughout this enrollment will default to Parent or Guardian 1 information.

Parent or Guardian 1

Relationship *

First Name *

Last Name *

Email *

Mobile Phone *

Add Parent or Guardian 2? *

Custody or Guardianship Documentation

Per Florida Statute 1002.20(3), schools must communicate with the legally authorized educational decision-maker. If the student is not living with both biological parents, or if there are court orders regarding educational rights (divorce decrees, foster care placement, legal guardianship), please upload the relevant documentation.

Custody Documentation Required? *

7

Siblings

Direct Pay families enrolling 2 or more students in similarly priced programs (Accelerate High School or Launch Prep) receive a 30% discount on the total family invoice.

Siblings enrolling or currently enrolled this term? *

8

Emergency Contacts

Per Florida Statute 1002.42, schools must maintain emergency contact information. Provide two contacts other than the parents listed above who are authorized to be contacted in case of emergency.

Emergency Contact 1

Full Name *

Relationship *

Phone *

Emergency Contact 2

Full Name *

Relationship *

Phone *

9

Health and Immunization Records

Per Florida Statute 1002.42(6), private schools must maintain current immunization records for every student. Per Florida Statute 1002.42(5), a school-entry health examination dated within 12 months of enrollment is required.

Immunization Status *

Immunization Record (DH 680 or DH 681) *

School Entry Health Exam (DH 3040) *

Health Information

Known Allergies

Current Medications

Medical Conditions

10

Required Forms Packet

Each form below opens for review and electronic signature. Upon signature, a PDF is generated and attached to your enrollment submission. All forms must be signed before submission.

Enrollment Portal

Student Enrollment

Community Outreach (Free Programs)

Proof of Identity

Payment Summary

Tuition Summary

Payment Summary

Parent or Guardian 1

Parent or Guardian 2

Custody or Guardianship Documentation

Emergency Contact 1

Emergency Contact 2

Health Information

Enrollment Received