REQUEST INFORMATION

Thank you for your interest in Eastgate Academy! We will open our school in August of 2018. At this time, as we assess unique student needs and prepare for growth, enrollment will be limited to Eastgate Church members.

Please fill out the form below and our Admissions Office will contact you with additional information.

Parent / Guardian Information

Name

First Name

Last Name

Email Address

I am a member of Eastgate Church

Yes

How did you hear about us?

Phone

(###)

###

####

Student 1

Name

First Name

Last Name

Gender

Male

Female

Grade Level of Interest

School Year

Student 2 (if applicable)

Name

First Name

Last Name

Gender

Male

Female

Grade Level of Interest

School Year

Student 3 (if applicable)

Name

First Name

Last Name

Gender

Male

Female

Grade Level of Interest

School year

Additional Comments

I understand that, at this time, Eastgate Academy is limited to Eastgate Church members.

Yes, I understand