Duchesne Academy

Applicant Information

Name of Applicant

First

Middle

Last

Suffix

Preferred Name

Applicant's Birth Date

mm/dd/yyyy

City/State/Country of Birth

Requested School Entry Year and Grade

Applying for Grade

Academic Start Year

Does your child receive any classroom or testing accommodations?

Yes No

School Information

School District of Residence

If other, please specify:

School Status

Current Grade

School Name

Please specify school name

School Address

Grades Attended

Has the applicant attended another school in the past?

Yes No

Prior School Name

Grades Attended

Demographic Information

This information is collected only for demographic and state reporting purposes. It does not influence admission decisions.

Gender

Female

Citizenship

Is the applicant Latino/Hispanic?

Yes No

Race

Please specify races (select all that apply)

Please list tribal affiliation

Primary Language Spoken at Home

Please Specify

Religion

Please Specify

Place of Worship