2022-2023 Enrollment Form

Intent to Enroll Form

* Indicates required field

Name of Scholar *

First

Last

Parent/Guardian #1 Name *

First

Last

Parents/Guardian #2 Name *

First

Last

Parent/Guardian Email *

Parent/Guardian Phone Number *

Address of Scholar *

Line 1

Line 2

City

State

Zip Code

Country

Birthdate of Scholar (MM/DD/YYYY) *

Gender of Scholar *

Female Male Prefer Not to Answer

Race/Ethnicity of Scholar *

Grade Enrolling For *

Previous School *

Current Grade of Scholar (Today) *

Current School District *

Has anyone in your family ever attended RVLA? *

Yes No

How did you hear about Rainier Valley Leadership Academy? *

Which of the following prompted you to apply to Rainier Valley Leadership Academy? *

By writing my name below I confirm that I am meaningfully interested in enrolling my scholar at Rainier Valley Leadership Academy for the 21-22 school year.

Signature *

Rainier Valley Leadership Academy does not discriminate in any programs or activities on the basis of sex, race, creed, religion, color, national origin, age, veteran or military status, sexual orientation, gender expression or identity, disability, or the use of a trained dog guide or service animal and provides equal access to the Boy Scouts and other designated youth groups.

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