Apply - Omega Middle School

Student lives with*

Mother & Father
Mother
Father
Guardian

Check any that apply

Parents Married
Parents Divorced
Parents Separated
Father Deceased
Mother Deceased

Who will accept financial responsibility for school tuition & fees?*

Mother
Father
Both

Is your child's enrollment dependent upon receiving tuition assistance?*

Yes
No

Parent / Guardian Information 1

Parent / Guardian Information 1*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Mobile Phone

Work Phone

Other Phone

Occupation*

Employer

Parent / Guardian Information 2

Parent / Guardian Information 2*

First Last

Is the Parent / Guardian address the same?*

Yes
No

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Mobile Phone

Work Phone

Other Phone

Occupation*

Employer

Parent / Guardian Information 3 (if applicable)

Parent / Guardian Name 3

First Last

Relationship

Address

Street Address Address Line 2 City State ZIP Code

Email

Mobile Phone

Work Phone

Other phone

Occupation

Employer

Maternal Grandparents

Grandparents are contacted a few times a year for school purposes - newsletters, invitations, and annual campaign.

Names

Address

Street Address Address Line 2 City State ZIP Code

Email

Phone

Paternal Grandparents

Grandparents are contacted a few times a year for school purposes - newsletters, invitations, and annual campaign.

Names

Address

Street Address Address Line 2 City State ZIP Code

Email

Phone

Name of School	City, State	Grades enrolled	Academic year(s)

Name	Name of School	Grade	Gender

Omega Middle School Application

Step 1 of 5

Parent / Guardian Information 1

Parent / Guardian Information 2

Parent / Guardian Information 3 (if applicable)

Maternal Grandparents

Paternal Grandparents

Educational History

Please respond to the following by indicating whether your child is:

Health & Behavioral Information

Name	Title	Phone number