Child's Name
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Child's Date of Birth
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Child's Grade
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Father's Name
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First Name
Last Name
Mother's Name
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First Name
Last Name
Father's Phone
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Country
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Mother's Phone
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Country
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Parent Email
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Mailing Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Past School/Homeschool/Educational Experience
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Does your child have any prevalent behaviors that Purposed Academy should be aware of?
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What are your child's passions and hobbies?
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What are your beliefs when it comes to your child’s education and the experience you hope he/she has?
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What are your child's academic frustrations?
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How would you describe your child’s interactions with his/her peers?
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What questions do you need answered when it comes to your child’s potential experience at Purposed Academy?
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Strengths as a Precious and Unique Child and Child's Academic Strengths:
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Briefly describe the ideal educational setting you would like to have for your child:
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Purposed Academy uses a customizable curriculum and benchmarks to create an individualized learning plan for each student within our care. Purposed Academy is not designed to track pace with Mississippi State Standards because we move at the pace of our students. However, we do utilize a curriculum that is nationally accreditation and/or aligned to common core standards. Briefly describe your expectations for your child’s education.
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Does your child have any special needs that need to be taken into consideration?
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If yes, please explain.
Has your child been diagnosed with allergies/anaphylactic reactions by a healthcare provider? If yes, please list all of the child's allergies including foods.
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Does your child react to skin contact with the allergen? If so, what is the reaction? And how soon after exposure does your child react?
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Does your child react to swallowing the allergen? If so, what is the reaction? How soon after the exposure does this child react?
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If applicable, what medical care was given in the past due the result of an allergic reaction?
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Does your child wear an identifying tag or bracelet alerting others to the allergy?
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Are medications required to be kept at school? If so, what kind?
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Are you comfortable with faith-based values infused within our curriculum and daily lessons?
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Purposed Academy Microschool believes God is the creator and sustainer of all things. We refer to biblical principles for operating and maximizing your child’s positive learning experiences.
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Are you able to commit to the financial obligations of $188 per week for 37 weeks broken into 37 payments starting August 6, 2025 and ending May 20, 2026?
Are you able to commit to the financial obligations of $625 per month for 12 months starting June 2, 2025 ending May 1, 2026 for full time attendance?
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Are you able to commit to the financial obligations of $750 per month for 10 months starting August 1, 2025 ending May 1, 2026 for full time attendance?
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Are you able to commit to the financial obligations of $7,500 annually with the payment due August 1, 2025 for full time attendance?
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Curious and Creative
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5
Self Motivated
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Able to Persevere
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Self-Directed Learner
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5
Completes Tasks
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5
Awareness of Personal Responsibility
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I am committed to being an active participant in my child's education.
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I understand that it is vital for the growth of my child that I, the parent, have a healthy awareness of my child's strengths and weaknesses. When conflict arises, I am committed to being a problem-solver and actively working to find solutions.
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I understand that Purposed Academy Microschool LLC is a collaborative community of parents, teachers, and students. I am committed to being a positive contributor to this learning community and encouraging my child to be an empathetic, active participant in their classroom with their peers.
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Parent Signature and Date (your typed name response will serve as your signature)
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First Name
Last Name