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Inquiry

Thank you for expressing your interest in Parkhurst Academy. 

To assist you better, we kindly ask you to complete the form provided below. Once we receive your submission, our Admissions Director will reach out to you promptly.

We eagerly anticipate the opportunity to provide any assistance you may need. Thank you once again for considering Parkhurst Academy.

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Last Name *
  • Email Address *
  • Confirm Email Address *
  • Cell Phone *
  •  
  • Student 1
  • First Name *
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
    Gender *
  • Grade Level of Interest *
    School Year *
  • Current School *

  • Has this student ever been evaluated for academic, behavior, emotional or learning difficulties by a school official, psychologist or other professional? Does this student have an IEP/504, Psychoeducational Evaluation, Psychological Assessment, or Behavior Plan?
    *

  • Does the student have any diagnosis?
    *

  • What type of school funding do you have?
    *

  • Has your student ever been suspended or expelled? If so, please write a brief explanation of the incident. 
    *

  • What program are you curious about?
    *

  • What is the best way we can contact you? 
    *
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes *
  •