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New Student Inquiry

Thank you for your interest in learning more about Great Lakes Academy.  We are happy to answer any questions that you have about our school. 

Please complete the information below and we will contact you as quickly as possible during regular business hours.  Thank you, we look forward to speaking with you soon.

The information required in this form is kept strictly confidential and is not shared with anyone other than appropriate GLA school personnel.

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Cell Phone *
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Cell Phone *
Home Address
  • Street Address *
  • City *
  • Country *
  • State
    *
  • Zip
    *
  • Home Phone
  • How Did You Hear About Us?
    Details:

  • Who does student reside with?
    *

  • What is your child's diagnosis, if any?
    *

  • If above you selected "Learning Difference" or "Other" please use this area to list and/or explain your student's diagnosis.

  • Issues your child is currently experiencing in school:
    *

  • Please feel free to explain difficulties your student currently experiences at school if not listed above.

  • Has your child ever experienced one or more of the following?  Please click on all that apply.

  • Please feel free to expand on your answer to the question above.

  • How did you hear about us?
    *

  • If you were referred to GLA by a Doctor, Therapist or friend, we would love to be able to thank them. Please list their name and/or contact information below.  Thank you.

  • What are your academic and/or social expections for your child?
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
    Gender *
  • Grade Level of Interest *
    School Year *
  • Student Interests
    Areas of Interest
    Sports
  • Current School
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •