Enrollment Form – Innovation Learning Academy

Student Name *

First

Last

Student DOB *

Grade Level *

Grade level for 2020-2021 academic school year.

Parent/Guardian Name *

First

Last

Phone *

Current Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Cannot be P.O. Box

What school is your student currently enrolled in? *

What school district is your student currently enrolled in? *

If other, please indicate which district *

Does your child have an IEP/504 plan? *

Which tuition plan are selecting? *

Please visit our Tuition & Fees page for more information at www.ilearnga.com/tuition-fees.