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Request Information

Thank you for your interest in Elizabeth Academy.

Please fill out the form below, and our Admissions Office will contact you shortly to provide additional information regarding your request.

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Work Phone
  • Cell Phone
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Work Phone
  • Cell Phone
Home Address
  • Street Address
  • City
  • Country
  • State
  • Zip
  • Home Phone
  • How Did You Hear About Us? (Check all that apply) *
    Details:

  • Would you like for your student experience a day at Elizabeth Academy Secondary School?  This is for students who will be in 7th-12th grade for the 2024-2025 school year.

  • Would you like to take a tour of our Elizabeth Academy Primary School, our campus for students Infants to 6th Grade?

  • Would you like to take a tour Elizabeth Academy Secondary School, our campus for students 7th to 12th grade?
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate
    (mm/dd/yyyy)
    Gender
  • Grade Level of Interest *
    School Year *
  • Student Interests
  • Current School

  • What are your top priorities for your student's education?
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •