SATELLITE MIDDLE & HIGH SCHOOL
8 WESTOWNE STREET, SUITE 800
LIBERTY, MO 64068
(816) 415-4822   fax (816) 792-1574

Satellite is nationally and locally accredited by AdvancED (nationwide), the North Central Association Commission on Accreditation and School Improvement (NCA CASI), the Commission on International and Trans-Regional Accreditation (CITA), and the National Private Schools Association Group.

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Print, complete, and mail this page along with your $25 registration fee. Include an order form and payment if you're ordering courses at this time. If possible, enclose a copy of your middle or high school transcript. If you are not able to provide one, we will request a copy from your school.

REGISTRATION FORM

FULL NAME

  FIRST MIDDLE LAST MAIDEN

DATE OF BIRTH AGE
ADDRESS
CITY / STATE / ZIP
TELEPHONE: HOME                                                         CELL/WORK:
PARENT/GUARDIAN'S NAME
PARENT/GUARDIAN'S ADDRESS (IF DIFFERENT)
CURRENT SCHOOL ATTENDED  (IF GRADUATING THROUGH SATELLITE, LIST THE LAST SCHOOL YOU ATTENDED)                                                                                                                           

 CURRENT GRADE LEVEL
ADDRESS OF CURRENT SCHOOL
CITY / STATE / ZIP OF CURRENT SCHOOL
CHECK ONE: YOU ARE A  __________ MIDDLE SCHOOL STUDENT OR __________ HIGH SCHOOL STUDENT

DOES YOU HAVE A CURRENT IEP (SPECIAL SERVICES EDUCATION PLAN)? __________

CHECK ONE: CREDITS WILL BE _____ RETURNED TO CURRENT SCHOOL OR   _____ USED TO GRADUATE FROM SATELLITE

PROCTOR INFORMATION

Local students may take their exams at our center in Liberty.  All other students need to select someone in their area to administer and supervise their course exams.  The student's exams will be mailed to this proctor, who will administer the exams and then mail them back to Satellite. You will need to arrange for your own test proctor. We strongly prefer that your proctor be a teacher, counselor, or administrator at any school (elementary through college). If that is not possible, alternate testing arrangements may be possible but you will need to contact our office for further information. Your proctor cannot be related to you or live in your home.

PLEASE CIRCLE ONE OF THE FOLLOWING:   I WILL TAKE MY EXAMS AT THE SATELLITE CENTER IN LIBERTY    or    I HAVE CHOSEN THE FOLLOWING PERSON TO BE MY PROCTOR

PROCTOR'S NAME
JOB TITLE OF PROCTOR  (COUNSELOR, TEACHER, ADMINISTRATOR, OTHER)
PROCTOR'S WORK (SCHOOL) ADDRESS
PROCTOR'S CITY / STATE / ZIP CODE
PROCTOR'S (SCHOOL'S) PHONE NUMBER

 

SATELLITE MIDDLE & HIGH SCHOOL

8 WESTOWNE STREET, SUITE 800
LIBERTY, MO 64068
(816) 415-4822  fax (816) 792-1574

REQUEST FOR RECORDS

STUDENTS: COMPLETE THIS REQUEST FOR RECORDS ONLY IF YOU PLAN TO GRADUATE FROM SATELLITE
DO NOT COMPLETE THIS FORM IF YOU ARE JUST TAKING CREDIT RECOVERY COURSES


DATE ____________________________

NAME OF SCHOOL ______________________________________________________

ADDRESS OF SCHOOL (IF KNOWN) _______________________________________

CITY/STATE/ZIP _________________________________________________________

THE FOLLOWING STUDENT HAS ENROLLED IN OUR MIDDLE AND HIGH SCHOOL. PLEASE SEND ALL AVAILABLE RECORDS OF
COURSES, GRADES, AND CREDITS EARNED.  IF A STUDENT HAS AN IEP ON FILE, PLEASE SEND THAT DOCUMENTATION AS
WELL. IT IS NOT NECESSARY TO SEND DISCIPLINARY RECORDS. IF ALL RECORDS TOTAL MORE THAN 10 PAGES, PLEASE
POST MAIL THE RECORDS RATHER THAN FAXING THEM.

STUDENT'S FULL NAME __________________________________________

DATE OF BIRTH __________________________________________________

GRADE ___________  LAST CALENDAR YEAR ATTENDED _____________

PARENT/GUARDIAN SIGNATURE ___________________________________
                                                                                                                           

OFFICE USE ONLY:
DATE(S) MAILED OR FAXED TO PRIOR SCHOOL: __________________________

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