Registration Form(s): | Tamu Sana Kanyama

Student Full Name*
Date*
Current Address*
Parent/Guardian #1 Name & Phone Number*
Parent/Guardian #1 E-Mail Address*
Custodial
- Yes
- No
Parent/Guardian #2 Name & Phone Number
Parent/Guardian #2 E-Mail Address
Custodial
- Yes
- No
Parents Completed High School*
- Both
- One
- Neither
Parents Attended College*
- Both
- One
- Neither
Marital Status*
- Married
- Divorced
- Separated
- Never Married
Student's Cell Phone Number
Student's E-Mail Address*
Date of Birth*
Current Grade Level*
Social Security or Student ID*
Sex*
- Male
- Female
Type of Enrollment being Requested :*
- Full Time Student (College Prep Program)
- Home School Collective - Full Nurture and Up to 4 additional classes
- Home School Support - Limited Nurture - Secondary Enrollment for On-Line Students
Type of Admission
- Traditional Admission: Student is matriculating from a school ( Public or non-connected Private School ) where 8th grade has been completed and the natural next step is a new institution.
- Home School Admission: Student is transitioning from a traditional home school setting.
- African Centered Matriculation: Student is matriculating from an identified African Centered program. [Children of The Most High, Imhotep Academy, Kilombo Pan-African Institute]
- Transfer Student

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Who will serve as Student's Primary learning support coach at home?:*
Coach's highest educational degree/certification ( High School Diploma Required):
Learning Coach is a custodial parent?*
- Yes
- No
If Potential Learning Coach is someone other than a custodial Parent, what is the relationship to the student?
Thank you for your interest in Tamu Sana Kanyama Preparatory Academy High School Program or Nurture Program for S.W.AT.L. Home School Connection. We look forward to meeting with you and your family. Someone from our staff will be contacting the parent listed as #1 to schedule an interview and admission test.
- I understand that this is not an offer of admission and that by completing this application I am requesting admission to this institution with knowledge of tuition costs and attendance requirements.

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