Bright Minds Academy Application Form

SECTION 1: Student Information

Student Full Name

Date of Birth

Month

Day

Year

Current Age

Grade Level for Upcoming School Year

SECTION 2: Parent / Guardian Information

Parent/Guardian Name

Phone

Address

SECTION 3: Educational Background

Name of Current/Previous School (if applicable)

Has your child ever been retained or repeated a grade? If yes, please explain:

SECTION 4: Academic & Learning Insight

How would you describe your child’s current academic level? (Select all that apply)

Ahead of grade level

On grade level

Below grade level

Needs additional support in certain areas

What subjects does your child do well in?

What subjects does your child struggle with?

Does your child have any diagnosed learning differences or require accommodations? If yes, please explain:

SECTION 5: Behavior & Learning Environment

How does your child typically learn best?

Independent work

Small group instruction

One-on-one support

Hands-on activities

Has your child ever had behavioral challenges in a learning environment? If yes, please explain:

SECTION 6: Parent Alignment & Expectations

Why are you interested in Bright Minds Academy?

What are you looking for in your child’s learning environment?

What concerns (if any) do you currently have about your child’s education?

SECTION 7: Program Understanding & Consent

I understand that Bright Minds Academy is a structured microschool program with required attendance Monday–Friday. I acknowledge that enrollment is limited and not guaranteed upon application, and that a Parent Meeting is required before enrollment. I also understand that academic assessment takes place after enrollment for placement purposes.

SECTION 9: Agreement

Signature

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Date

Application Fee

$30