Student Information Student First Name * Student Last Name * Gender * - Select -MaleFemaleOther Student's Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year2001200220032004200520062007200820092010201120122013201420152016201720182019202020212022 Grade Entering * - Select -k123456789101112 Last School Attended Household Location Information Street Address * Apartment # City * State * Zip Code * Parent/Guardian/Contact Information Parent First Name * Parent Last Name * E-Mail * Daytime Phone * Other Phone Referred By * - Select -FriendFacebookInternetNewspaperPostcardOther Does your child have an active IEP (Individualized Education Plan)? * Yes No Please provide to the office at Conner Creek Academy East: • Copy of the most current IEP paperwork (last or current school year) • Copy of the name and phone number of last school (even if different from the IEP) Kindergarten Only • Please provide on the application the last pre-school attended if your child received Programs and Services such as ECDD Classroom, Speech Therapy and other related Services. • Provide current Transition IEP Is your child currently under expulsion from another school? * Yes No List siblings that attend or have an application to attend MI Collegiate or CCAE Sibling #1 Sibling #1 Grade Sibling #2 Sibling #2 Grade Sibling #3 Sibling #3 Grade Sibling #4 Sibling #4 Grade
