Business Office:
3850 Broadmoor, S.E. Suite 201 Grand Rapids, MI 49512
(800)223-6402 | (616)222-1700 | Fax: (616) 575-6801
Website: www.heritageacademies.com


 
Application Year: *    


Student Information

Please provide the following information about the student.  When you have completed the form, click Continue.
 
Child's First Name: * 
Child's Last Name: * 
Child's Middle Name:
Child's Name Suffix:    Gender: *   
Birth Date: * 

  (mm/dd/yyyy)

 City of Birth: * 
State of Birth:
* If born in USA 
Country of Birth: * 
Last School: *   Enter "None" if no prior school. 
School District where Applicant Resides:
 

 * Denotes required field.