REGISTER

APPLICATION FOR SCHOOL!

Date: Parent Name:
Phone: Cell Phone:
Student Name: Grade:
Race: Email:
How did you hear about us?  Friend Relatives Radio Internet TV Other
What school did your student attend?
Where there behavior problems?
If yes please explain.

Has the student ever been expelled?
If Yes please explain

Are there any special needs? Please check all that apply  IEP MFE 504 Plan

Are you an active parent in your child's education?
If No please explain

Would you be willing to do the following  Volunteer Chaperone

Can the Parent Resource Team contact you? Please choose the current grade. 5th 6th 7th 8th Unsure CR

Student Essay: All students entering Mosaic Middle School must complete. Please state in your own words why you think that an education is important to you and what you plan to do upon graduation. Minimum 250 words.

Parent Guardian Information
Name: Relationship to Student
Address:

Name: Relationship to Student
Address:

The final step in the application process the guardian must provide the following documents. Please gather and fax to 678.609.1479. Please include you child’s name on the fax cover sheet. You may also scan you documents and email them to info@mosaicschools.org.

The parent or guardian must also download our document check list here. (http://www.mosaicschools.org/wp-content/uploads/2012/03/document-check-list.pdf) Please print out the document and fill out and sign where needed. Please send all the documents together.

Any questions please give us a call at (888) 793-8826


CONTACT US




NAME

PHONE

E-MAIL

QUESTIONS and COMMENTS

“Click on Button to Send”