Clay Academy

Online Interest Form

Fill out the online interest form today and one of our Admissions Representatives will contact you as soon as possible. You can fill out the interest form right now, without having to leave your seat.


Student Information


Student's Last Name *

Student's First Name *

Student's Middle Name

Student's Date of Birth

Student's Grade Level

Parent or Legal Guardian's Last Name *

Parent or Legal Guardian's First Name *

Parent or Legal Guardian's Middle Name

Parent or Legal Guardian's Email *


Mailing Address


Student's Permanent Street Address:

City

State

Zip

Parent or Guarding Mailing address (If different)

City

State

Zip


Student Information


Student's Gender	Male Female

Student's Ethnicity	Anglo Hispanic Native American African American Other

Health Concerns

Physician

Physician contact number

Preferred Hospital


Parent or Legal Guardian's Information


What is the best way to contact you?	Home Phone Work Phone Mobile Phone Email Address Pager

Your Daytime Phone *

Work Schedule	Day Night


Mothers Information


Mothers Name

Work Phone

Mobile Phone

Occupation

Email Address

Emergency Contact Name

Emergency Conact Number

Work Address

City

State

Zip


Fathers Information


Fathers Name

Work Phone

Mobile Phone

Occupation

Email Address

Emergency Contact Name

Emergency Conact Number

Work Address

City

State

Zip

Admissions

Tuition Costs

Frequently Asked Questions

Online Interest Form

Application Form

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