enroll

Application for 2017-2018 Enrollment
Memphis College Prep is currently accepting applications for incoming Kindergarten, through Fifth Grade scholars.

STUDENT INFORMATION


Student Name Fields with (*) are required.
First Name : *
Middle Name :
Last Name : *
Telephone Number : * [xxx-xxx-xxxx]
Home Address
Street Number : *
Street Name : *
City : *
State : *
Zip :
Gender : *
Birth Date : *  
Does the student currently receive special education services under an Individualized Education Plan (IEP) or 504 plan? *
 
What grade will your student be entering in the 2017-2018 school year? *





 
Is the student currently enrolled in a Pre-K or preschool program?
If Yes,Where?:
If your scholar is entering 1st through 5th grade, where is your scholar currently enrolled? *
Where?:

FAMILY INFORMATION
Name of Parent/Guardian
First Name : *
Middle Name : *
Last Name :
Relationship to Applicant : *
Home Address
Street Number : *  
Street Name : *
City : *
State : *
Zip : *
Mailing Address (if different from student home address)
Street Number :
Street Name :
City :
State :
Zip :
Homephone :
Work Phone :
Cell Phone : * [xxx-xxx-xxxx]  
E-mail : *

Please provide the following information about the applicant's siblings. Please remember that each child will need to submit a separate application for enrollment.
Name Name Name
Age Age Age
How did you hear about Memphis College Prep Elementary School?
APPLICANTS PLEASE NOTE:
It is the responsibility of the applicant to guarantee all information is accurate. You must notify Memphis College Prep Elementary if your contact information changes. Only one application may be submitted for each student applying. All questions should be directed to Director of Special Projects, Brittany Byrd or Operations Manager, Victoria Brown at 901-620-6475.
 
     
    
Memphis College Prep • 278 Greenlaw Ave • Memphis, TN 38105 • (901) 620-6475