Registration – Achievers Academy Baker, LA

Name *

First

Last

Student Email *

Contact Phone Number

Please enter the primary phone number to contact for the student.

Current School You Attend

Student Grade Level

Parent/Guardian Name

Parent/Guardian Phone Number

Current Address

Example: 12345 Front Street, Baker LA, 70714

Is Transportation needed?

Please indicate your Tee Shirt Size

Do you have an IEP at your current school?

Please list any specific areas of tutoring you may need.

Please list any accommodations that you may need?

Program Registration Form