To register, please print the form, fill up, and mail or FAX to:

Creative Learning Services School
482 Staines Ct
St Louis, mo 63141
FAX: 866-237-1080
 

REGISTRAR APPLICATION FORM

Student’s Full Legal Name :
Please Print (Last, First, Middle)

Student’s Social Security Number:

Student’s Address:

Student’s Phone Number:

Fax Number:

Student’s Email Address:

Student’s Birthdate:

Student’s Current Age:

Male __    Female __

Resident School District:

Last School Attended:

Date of Last Attendance:

School Type: Private  __     Home School  __     Public  __

Address of School:

Phone Number of School:

Grade entering:

Have you received Special Education services in the past?

Do you have an Individualized Learning Plan (IEP)?

Guardian name (Last, First, Middle):

Guardian's Relationship to Student:

Guardian’s Address:

Guardian's Phone Number:

Guardian's Fax Number:

Guardian's Email address:

We want to make sure that the Cyber School will be a good "fit" for you. In order to help us determine this, please write a few lines answering this question: How do you think enrolling in the Cyber School will benefit you?

Occasionally, students need help on Cyber School assignments during evenings or on weekends. Do you have an adult family member or friend who can help you with your assignments? Yes ______ No ______

Please provide us with the names and telephone numbers of 2 adult references. These references CANNOT be members of your family, but should be adults who know you well enough to tell us if Cyber School will benefit you.

Reference #1 name and phone #:
Reference #2 name and phone #: