Enrollment - Glass City Academy

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Email

district@glasscityacademy.org

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Phone

419-720-6313

Enroll Now

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About
Locations
Academics
Faculty
Students
Parents
News/Events
PowerSchool Login
Resources
Contact

Admission

Glass City Academy is open to all student ages 15-21 years of age from any school district in the great State of Ohio, including the Greater Toledo Area, and its outlying suburbs and communities. To enroll a student at Glass City Academy a parent/guardian/adult student needs to fill out the enrollment paperwork below.

Glass City Academy had a waiting list last year of over 150 students. If you are interested in enrolling your child, please do so quickly as we will fill up fast again this school year.

A copy of the Internet Usage Form can be found here.

Questions can be directed to Jordanne Marks at 419-720-6313.

Enrollment Form

Which Glass City Academy would you like to attend?(Required)

Downtown Campus - 1000 Monroe St. Toledo, OH 43604 419-720-6311

East Campus - 1430 Idaho St. Toledo, OH 43605 419-214-5973

Either

First Name(Required)

Middle Name

Last Name(Required)

Home Phone

Day Phone

Home Address

Proof of Residency (Upload 1 of the following: Utility bill, Lease, or Bank Statement)

Max. file size: 1 GB.

Birth Certificate

Max. file size: 1 GB.

Custody Papers

Max. file size: 1 GB.

Gender(Required)

Male

Female

Date of Birth(Required)

MM slash DD slash YYYY

Birth Place (City, State)(Required)

SSN

Photo/Video Permission(Required)

Yes

Internet and Technology Release: I have read the Internet Use Policy found above and I agree to abide by it.(Required)

Yes

Student's Race(Required)

White, Non-Hispanic

Black or African American

Asian

American Indian or Alaskan Native

Hawaiian or Other Pacific Islander

Hispanic or Latino

Parent or Guardian Information

Who has primary custody of the student?(Required)

Relationship to student?(Required)

Parent/Guardian 1

Parent 1 First Name(Required)

Parent 1 Last Name(Required)

Parent 1 Day Phone(Required)

Parent 1 Cell Phone

Parent 1 Relation to Student

Parent 1 Email Address(Required)

Parent/Guardian 2

Parent 2 First Name

Parent 2 Last Name

Parent 2 Day Phone

Parent 2 Cell Phone

Parent 2 Relation to Student

Parent 2 Email Address

Emergency Contacts

Emergency Contact 1 First Name

Emergency Contact 1 Last Name

Emergency Contact 1 Phone Number

Emergency Contact 1 Relationship to Student

Emergency Contact 2 First Name

Emergency Contact 2 Last Name

Emergency Contact 2 Phone Number

Emergency Contact 2 Relationship to Student

Additional Information

What device (if any) is available to you for online learning?(Required)

Laptop, Desktop, Tablet

Smart Phone

Neither

What type of data connectivity is available for online learning?(Required)

Broadband access from home (cable, DSL, etc)

Cellular connection from home (hotspot)

No connection from home

Name of any previous schools attended(Required)

Has the student ever enrolled with Glass City Academy before?(Required)

Yes

Is the student currently receiving special education services?

IEP/ETR

504 Plan

Has the student completed at least 1 year of 9th grade?

Yes

Is the student currently on explusion from a previous school?

Yes

What is the expulsion end date?

MM slash DD slash YYYY

Is the student currently on probation or parole?

Yes

If yes, what is the PO's name?

If yes, what is the PO's phone number?

Economical Disadvantage (Select all that apply).(Required)

Resident of a household which a member of is eligible for Free and Reduced Price Lunch

SSI

SNAP (Food Stamps)

TANF

Child Care Assistance

Not Applicable

Please list any medical conditions or allergies the student may have.

As a parent or guardian I authorize medical personal to render necessary medical treatment to my student. I give consent to release information to Glass City Academy personnel to promote the health and safety of my student, thus enhancing his/her ability to learn. If deemed necessary your child will be sent to the emergency room at the parents expense.(Required)

Yes

By typing your name below, you are signing this Application electronically, which shall have the same legal equivalent of a physical signature. By signing electronically, you attest that the information is true and accurate, to the best of your knowledge, and that you are legally authorized to apply for enrollment on behalf of the Student. By signing electronically, you consent to the Student’s enrollment at Glass City Academy. Glass City Academy reserves the right to require that you provide a physical signature on this and any other electronically signed documents in future. (please enter parent/guardian name, student name and current date.)(Required)

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