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Student Application Form

Please complete the student application form below for students entering grades 6 - 8 in the Fall of 2019. Required fields marked *

Contact Information

Parent First Name*

Answer Required

Parent Last Name*

Answer Required

Child's First Name*

Answer Required

Child's Last Name*

Answer Required

Child's Current Grade*

Answer Required

Child's Current School

Answer Required

Does your child have an IEP? (IEP students have preference)*

Answer Required

Yes

Does your child have a sibling who attends CAMPA? (Siblings have preference)*

Answer Required

Yes

Home Address

Street Address*

Answer Required

City*

Answer Required

State*

Answer Required

Zip/Postal*

Answer Required

Email 1*

Answer Required

Mobile Phone*

Answer Required

Home Phone

Answer Required

Work Phone

Answer Required