Bridges Community Academy
Student Admission Form
STUDENT INFORMATION:
Social Security Number:

Today's Date:
First Name: Middle Name:
Last Name: Date of Birth:
Street Address: Apt.#: Gender:
City: State: Zip:
Home Phone:
Family Email Address:
Current School District:
Current Building:
Current Grade Level Current Age
Ethnicity:
Contact information of the Parent / Guardian with whom the student resides:
First Name: Last Name:
Home Phone: Work Phone:
Cell Phone: Other Email:
Anticipated Start: Please indicate why you would like your child to attend BCA:





Is your child currently identified gifted? In what areas?
(Please be aware that proper documentation will be needed for identification areas.)
NONDISCRIMINATION STATEMENT:
Bridges Community Academy do not discriminate on the basis of race, color, creed, national origin, ancestry, sex, age, religion, veteran status, or disability (ADA) in admission to, access to, treatment in, or employment in any service, program, or activity sponsored by Bridges Community Academy.