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Admission Information Request Form

Admissions for the 2017-2018 school year is currently closed.

Thank you for your interest in the Christina Seix Academy. We are excited about your interest in our school. The admission process will begin again in November of 2017, when we will begin accepting applications from students who will be 3 years old for the 2018-19 school year.

Please complete the form below to receive additional information.

Remember, applicants must meet the following criteria to be considered for admission:

1. All students must live with a single adult (mother, grandmother, uncle, aunt, etc) demonstrating economic need;

2. All students must be 3 years old by September 2018;

3. All students must live in the greater Mercer County Area.

1. Parent/Guardian's First Name *This question is required.

2. Parent/Guardian's Last Name *This question is required.

3. Parent/Guardian's Email Address *This question is required. This question requires a valid email address.

4. Parent/Guardian's Phone Number *This question is required. This question requires a valid number format.

5. What is your legal marital status? *This question is required.

6. How did you find out about CSA? *This question is required.

Internet Search
CSA Student Family
Organization
CSA Staff Member
Other

What is the organization? *This question is required.

Name of CSA staff member who referred you. *This question is required.

Which CSA family referred you? *This question is required.

About the Applicant

7. First Name *This question is required.

8. Last Name *This question is required.

9. Date of Birth *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

10. Gender *This question is required.