Century Academy for Excellence

2019-2020 Re-registration enrollment application

2019-2020 Re-Registration Application

Student Name *

First

Middle

Last

Date of Birth *//

Grade in August *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home phone number *

Parent/Guardian 1 Name *

First

Middle

Last

Relationship to student *

Parent/Guardian 1 Email *

Parent/Guardian 1 Cell phone number *

Parent/Guardian 2 Name *

First

Middle

Last

Relationship to student *

Parent/Guardian 2 Email *

Parent/Guardian 2 Cell phone number

Career Technical Education Pathway (CTE) Choice (selection not guaranteed) *

Email

Contact Us

Email
info@centuryacademy.org
Phone
(323) 752-8834
Address
2400 West 85th St
Inglewood, CA 90305

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