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Inquiry Application

Thank you for your interest in Learning Independence for Tomorrow, Inc. (LiFT).

Please complete the Inquiry Form below:

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Last Name *
  • Salutation
  • Email Address *
  • Confirm Email Address *
  • Work Phone
  • Cell Phone *
Home Address
  • Street Address *
  • City *
  • Country *
  • State
    *
  • Zip
    *
  • How Did You Hear About Us? *
    Details:
  •  
  • Student 1
  • First Name *
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
    Gender
  • Grade Level of Interest *
    School Year *
  • Current School

  • Is your student gifted, at grade level or falling behind in the academic area of Mathematics? 
    *

  • Is your student gifted, at grade level or falling behind in the academic area of reading comprehension? 
    *

  • Describe your students abilities in Speech.
    *

  • Does your student have any added needs related to behavior.
    *

  • Does your student have a diagnosis? 
    *

  • Is your student able to use the restroom on their own?
    * Yes   No

  • Is your student able to feed themselves?
    * Yes   No

  • Will your student need to take any medications during school hours? 
    * Yes   No
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •