AdmissionApply NowAdmission StepsAllen Creek TuitionSchedule a ConsultationApply Now Welcome to Allen Creek Academy!Please fill out our application form below."*" indicates required fieldsStep 1 of 425%Student InformationStudent Name* First Middle Last Student Gender*MaleFemaleGrade applying for:*9th Grade10th Grade11th Grade12th GradeBirthdate* Month Day YearBirth Certificate Upload Drop files here or Select filesMax. file size: 256 MB.Please upload your child's birth certificateBirthplace* City State CountryAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Home Address* Street Address City State / Province / Region ZIP / Postal Code Primary Phone*Cell PhoneEmail Address* Current School Now Attending*Current Grade*8th Grade9th Grade10th Grade11th Grade12th GradeSchool Address* Street Address City State ZIP / Postal Code Family InformationNot applicable Check here if not applicable (e.g. single parent)Father's Name* First Middle Last Father's Birthplace*Father's Religion*Father's Occupation*Father's Marital Status*Is the last name different from the applicant's last name?* Yes NoIf name is different from applicant's, what name is used?*Not applicable Check here if not applicable (e.g. single parent)Mother's Name* First Middle Maiden Maiden NameMother's Birthplace*Mother's Occupation*Mother's Marital Status*Is the last name different from the applicant's last name?* Yes NoIf name is different from applicant's, what name is used?*Are the child's parents divorced?* Yes NoIf divorced, who has legal custody of the applicant*Mother/GuardianFather/GuardianNot applicable Check here if not applicable (e.g. single parent)Guardian's Name* First Middle Last Guardian's Birthplace*Guardian's Occupation*Guardian's Marital Status*Is the last name different from the applicant's last name?* Yes NoIf name is different from applicant's, what name is used?*Parent/Guardian QuestionnaireChild Applicant's Name* First Last Nickname*Entering Grade*Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th GradeBirth Date* Month Day YearPresent Age*Previous School(s)Previous School(s) attendedName of SchoolFrom Month Day YearTo Month Day YearName of SchoolFrom Month Day YearTo Month Day YearName of SchoolFrom Month Day YearTo Month Day YearUpload 2 Years of Report Cards and Standardized Test ResultsPlease upload the last 2 years of the student's report cards and standardized testing. Drop files here or Select filesMax. file size: 256 MB.Additional StudentsNames and grades of other family children applyingAdditional Student(s)Please add any information that might be pertinent in helping us evaluate this application.*How do you plan to contribute your time and talent to the school community?*Family Education HistoryNot applicable Check here if not applicable (e.g. single parent)Father's Elementary SchoolElementary School Address City State Father's High SchoolHigh School Address City State Father's CollegeCollege Address City State Not applicable Check here if not applicable (e.g. single parent)Mother's Elementary SchoolElementary School Address City State Mother's High SchoolHigh School Address City State Mother's CollegeCollege Address City State Any other family background information that you would like to addPayment InformationApplication Fee Price: Application Fee Total Billing Address* Street Address City State / Province / Region ZIP / Postal Code How would you like to make your payment?* Bank Account/ACH Debit/Credit CardCredit CardAmerican ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Security Code Cardholder Name Bank DetailsConsent I agree to the payment policy below.I authorize the company named on this web form to debit the bank account or credit card indicated in this web form, for the noted amount on today's date. This payment is for the goods and services noted on the web payment form. I understand that returns, refunds and cancellations are not permitted, however exceptions may be made on a case-by-case basis. I understand that because this is an electronic transaction, these funds may be withdrawn from my account as soon as the above noted transaction date. I agree that payments for billing schedules with common bill dates may be consolidated into a single payment. In the case of an ACH Transaction being rejected for Non Sufficient Funds (NSF) I understand that the company named on this web form may at its discretion attempt to process the charge again within 30 days. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card or bank account, and that I will not dispute the payment with my Credit Card Company or Bank, so long as the transaction corresponds to the terms indicated in this web form. Δ
