Apply Fill out this form, and let’s get started on your child’s journey with Connection Academy. Student Info Name * First Name Last Name Date of Birth * Enter Student Info Address Address 1 Address 2 City State/Province Zip/Postal Code Country Last Grade Completed * N/A Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade Last School Attended * Parent/Guardian Info Name * First Name Last Name Phone (###) ### #### Email * Guardian's Mailing Address is Same As Student's Yes No Tell Us More What interests you about our program? What do you hope your child will gain from CA?: * Describe your student’s academic and personal strengths: Describe your student’s academic and personal weaknesses: CA is a parent-teacher partnership. Are you able to commit to keeping your child on track on off-campus school days?: Thank you!