Name
*
First Name
Last Name
Nickname (if applicable)
Date of Birth
*
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Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Cell Phone
*
(###)
###
####
Email
*
US Citizen
*
Yes
No
Gender
*
Female
Male
Transgender
Non-Binary
I don't identify with any gender
Prefer not to state
Ethnicity
American Indian or Alaska Native.
Asian.
Black or African American.
Native Hawaiian or Other Pacific Islander.
White.
Two or More Races.
No Response.
Highest Level of Education Completed
*
9th Grade
High School Diploma
GED
Some College
Other
Program of Interest
Start Date of Interest *Choose one
*
Payment Option *Choose one
Shirt Size
*
Right or Left Handed
*
Right Handed
Left Handed
How did you hear about Atlas Academy?
*
Online Search
Family Member/Friend
Current Student
Alumni
If referred by a current or alumni student, please share who:
Electronic Signature
*
Date
*
MM
DD
YYYY
Guardian Electronic Signature (if applicable)
Date
MM
DD
YYYY