TRECA Digital Academy
Application for Admission

Please Note: All information remains confidential.
Much of this information is required by the Ohio Department of Education and is used for statistical purposes.
This application should be complete.
Thank you for you cooperation.

What will be required after completing the online application?

Would you prefer to mail a paper application, instead? You can print one here.

Part I: Student Information

Last Name:
 First Name:
Middle Name:
 Name Used:
 Append (Jr., III, etc.):
Street Address:
 City:
Apt., Lot, or P.O. Box:
 State and Zip Code:
Home Phone Number:
() 		Ohio County of Residence:
Cell Phone Number:
()
Contact Email:
Date of Birth (mm/dd/yyyy):
 Birth City and State:
Gender:
 Mother's Maiden Name:
Ethnicity:
Ever attended online school before?
Yes No		 If Yes, name of online school:
Current Grade:
 Last Grade Completed:
Is currently attending school?
YesNo 		Is currently Home-Schooled?
YesNo
Name of last school attended:
 Approx. last att. (mm/dd/yyyy):
 Reason for leaving:

Part II: Legal Guardian Contact Information

Applicant lives with Mother:
YesNo 		Applicant lives with Father:
YesNo
If applicant does not live with either parent, then please use the Comments field to provide contact information for the legal guardian instead. Include address, if different than the applicant's address.
Mother's First Name:
 Mother's Last Name:
Mother's Address:
Mother's City:
 Mother's State and Zip Code:
Mother's Area Code and Work Phone:
() ext.
Father's First Name:
 Father's Last Name:
Father's Address:
Father's City:
 Father's State and Zip Code:
Father's Area Code and Work Phone:
() ext.
Contact Mailing Address
(if different than applicant):
Mailing City:
Mailing Address Line 2:
 Mailing State and Zip Code:
Notes and Comments (optional):

Part III: Special Needs Information

Does applicant have special educational needs:
YesNo
If yes, the school will contact you promptly so that all appropriate arrangements can be made.

Part IV: Educational Management Information Request

School Year Applying for:
2009-2010
2010-2011		 TRECA will provide an Internet Service Provider for a home phone line. You may at your cost use another internet provider:
Native Language:
 Shoe Size:

Nike recommends a half size larger than your regular street shoe size. Nike+ shoes will be issued to all full-time students as part of the Health and Wellness program.

How did you learn about us:
If other, please specify:
Approx. schedule this semester:
(Optional. All schedules require Guidance Office approval.)