Enrollment Application

Student's First & Last Names

Student's preferred or Hebrew name (Type N/A if none or same as given name)

Date of Birth

Gender

Birth Certificate

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Last Report Card

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If Homeschooled, please summarize what was completed in the previous school year.

If your child has an IEP, 504 or has been identified a Gifted, tell us about if. If not type N/A

Passport/License

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Strengths and Weaknesess in Subject Area(s)

Student e-mail address

Intended Start Date

Parent/Guardian

Best Contact Number

Relationship

E-mail address

Work Number

Address

City

Address Line 2

Region/State/Province

Postal / Zip code

Emergency Contact

Relationship

Phone

E-mail

Spiritual/Cultural Affiliation

Add referral if applicable

I understand 1. If my $125 enrollment fee is unpaid my child is not officially enrolled at DDA 2. Student absences will not result in reduced tuition.

Donate: Be the Light to Ignite Our Children's Intellect

Zelle: DivineDedicators@gmail.com

Enrollment Application