1615 Belton  Garden City, Michigan 48135

734-261-0500  Fax: 734-956-6360

Principal  Suzanne March                                                   
         
ENROLLMENT APPLICATION
 
Name (full) ____________________________________________________Age_____Sex_____
 
Address________________________City_____________Zip_______Date of Birth__________
 
Home Phone_________________________Cell Phone__________________________________
 
Email Adress____________________________________________________________________
 
Last School Attended and Address___________________________________________________
 
School District Where You Live and County Your Home Resides In_________________________
 
How did you hear about Tipton Academy (newspaper, friend, etc):__________________________
 
Grade which student is enrolling at Tipton Academy: _____________________________________
 
Has your child ever been suspended or expelled from another school district? Yes______ No______ 
 
Is your child currently eligible for Special Education Services?   Yes_____   No______ Does your child have a current IEP?   Yes_____   No_____ 
 
Is your child currently eligible for Section 504 services?              Yes_____   No______
Ethnic:  Caucasian_______ Asian______ African American______ Hispanic_______ American Indian________ Other _________________
♦ Is the primary language in your home OTHER than English? Yes______ No________ ♦ If YES, what language? _____________________ ♦ ENGLISH LANGUAGE LEANER:  Has the student ever been enrolled in a Bilingual or English Language Learner (ELL) program?  Yes______ No_______

Signature of Parent/Guardian                                                                                Date