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Mojave River Academy Enrollment Interest Form

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Thank you for your interest in enrolling with Mojave River Academy! Please complete this interest form and a member of our team will reach out to you.

Student Information

Legal First Name*

Answer Required

Legal Middle Name

Answer Required

Legal Last Name*

Answer Required

Preferred Name

Answer Required

Grade Entering*

Answer Required

Date of Birth*

Answer Required

First language spoken by student*

Answer Required

Languages spoken at home*

Answer Required

Address

Street Address*

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City*

Answer Required

Zip/Postal*

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Home Phone*

Number Required

Parent 1 Information

First Name*

Answer Required

Middle Name

Answer Required

Last Name*

Answer Required

Email*

Answer Required

Mobile Phone*

Number Required

Work Phone

Number Required

Parent 2 Information

First Name*

Answer Required

Middle Name

Answer Required

Last Name*

Answer Required

Email*

Answer Required

Mobile Phone*

Number Required

Work Phone

Number Required

Which Mojave River Academy site(s) are you interested in?

Please select all that apply

Answer Required

This form is to express interest in enrolling with Mojave River Academy independent study. This is not a guarantee of enrollment. Once you have submitted this form, a member of our enrollment team will reach out to you with next steps. Thank you for your interest in Mojave River Academy and we look forward to speaking with you.

Confirmation Email

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