Admissions Application

I am interested in applying beginning*
- Fall
- Winter
I am interested in applying beginning in
How did you hear about Noorthoek Academy?
Current schedule- more details on semester registration forms.
Arts and Sciences 100:
- Wednesday 9:30 a.m-11:15 a.m.
- Wednesday 11:30 a.m-1:15 p.m.
- Thursday 10:00 a.m.-11:45 a.m.
- Thursday 12:30 p.m.-2:15 p.m.
- Friday 1:00-2:45 p.m.
- Saturday 10 a.m. - 11:30 a.m.
Creative Writing 100:
- Friday 11 a.m.-12:30 a.m.
Today's Date*
Student Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Cell Phone
Date of Birth*
Gender
Email
Who do you live with?*
Parent/Relative Name*
First Last
Parent/Relative Email*
Parent/Relative Phone*
Contact person name*
First Last
Contact person Email*
Contact person phone number*
Do you have a caseworker or other support professional?
- Yes
- No
Caseworker Name*
Agency
Phone*
Phone extension
Email*
Please list names, email, and phone numbers for any other caseworkers or support professionals.*
Parents/ Caseworkers- Interested in volunteering during classes?
- Yes
- No
Important Information about Disabilities & other medical info.*
High School Attended*
Year of High School Graduation/Completion*
Name
If you completed high school in the last 5 years, please provide a person from your school who we can contact.
School contact person phone number
List any activities in which you participate (Sports, clubs, music, etc.)
Job/Workplace
Volunteer
Why do you want to attend Noorthoek Academy?*
Students are responsible for providing their own transportation to and from classes. Do you need help with this?
- Yes
- No
Tuition is $250 for one semester. If you choose and are accepted into multiple classes, you receive a discount for each subsequent class. Tuition is NON-REFUNDABLE. If you are in financial need, partial scholarships are available.
Signed*
I agree that if I am accepted by Noorthoek Academy, I will abide by the rules, expectations of the staff, and board of directors. I understand that any inappropriate behavior (aggressiveness, inappropriate sexual conduct, etc) could result in the termination of my attending Noorthoek Academy.
Date*

For more information or to discuss financial need, please call the Education Director at 616-634-8352.