Florida Intercultural Charter School

FIA Enrollment Application

 

Florida Intercultural Academy
Intent to Enroll Form

Student Information

First Name:  
*		 Last Name:
*
Date of Birth:          Format: 00/00/0000

Gender:
Male    Female

Nationality:     
Address:      Address2:
City:              State:        
Zip Code:      Home Telephone:
Grade Student Entering 2007 Assigned Elementary School:

Parent / Guardian Information
Parent / Guardian #1
Parent / Guardian #2
First Name:   First Name:  
Last Name:   Last Name:  
Work Phone: Work Phone: 
Cell Phone:    Cell Phone:   
Email:          * Email:     
How did you hear about FIA?

 

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"Education is for improving the lives of others and for leaving your community and world better than you found it."
Marian Wright