Online Application  



Application Information

Application Fee
A $75.00 fee Non-refundable

Fall Enrollment
A  $250 registration fee is required to secure a space for each student
This amount is applied to the last month's tuition of contract.

Summer Enrollment
A deposit of $250 is required to secure a space for each student.
(Non-refundable/Deposit is applied to tuition.)

To pay fees by credit card, please call Admissions 818-952-3055.

Mail checks to:
Admissions,
Renaissance Academy,
4490 Cornishon Avenue, La Canada, CA 91011
(Please include the student name on your check.)

Student Information

(Student's Name)

Last:  First: 
Middle:  Nickname: 


Birth Date: (mm/dd/yy)  Age: 
Last Grade Completed: 


Applying For:
 10-month program  12-month program
 English as a Second language (ESL)  Tutoring
 Summer Program

Parent/Guardian Information

Correspondence to:
 Father  Mother  Guardian

Father
Father: 
Street Address: 
City:  State:  Zip Code: 
Home Phone:  Work Phone: 
Cell Phone:  E-mail: 

Mother
Mother: 
Street Address: 
City:  State:  Zip Code: 
Home Phone:  Work Phone: 
Cell Phone:  E-mail: 

Guardian
Guardian: 
Street Address: 
City:  State:  Zip Code: 
Home Phone:  Work Phone: 
Cell Phone:  E-mail: 

Financially Responsible Person:
 Father  Mother  Guardian  Other 

Schools attended in the last 2 years:

(List current school first)

School Name: 
Street Address: 
City:  State:  Zip Code: 
Phone:  Date Attended: 

School Name: 
Street Address: 
City:  State:  Zip Code: 
Phone:  Date Attended: 

School Name: 
Street Address: 
City:  State:  Zip Code: 
Phone:  Date Attended: 

School Name: 
Street Address: 
City:  State:  Zip Code: 
Phone:  Date Attended: 

Additional Information

Is the student failing a subject(s)?
(If yes, please explain) 		    Yes  No


Has applicant ever been dismissed or suspended from a school?
(If yes, please provide details) 		    Yes  No


Would you like to schedule pre-enrollment testing?
(If yes, please provide preferred testing date. If no, we will contact you to schedule a date.)		    Yes  No

I hereby make application for enrollment. I understand this application is subject to acceptance by the school.

 

 

 

 
Renaissance Academy
4490 Cornishon Avenue
La Cañada, CA 91011
tel: 818.952.3055


© 2007 Renaissance Academy. All Rights Reserved.
An Applied Scholastics™ School. Applied Scholastics and the Applied Scholastics open book design are trademarks and service marks owned by Association for Better Living and Education International and are used with its permission. Renaissance Academy does not discriminate on the basis of race, color, national or ethnic origin in administering student admissions or any of its administration policies.