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Are you interested in learning more about what Lake Michigan Academy can do for your child? Complete this form and we will be in touch soon!

    Student Information

    * Indicates required field

    Date *

    Present Grade: *

    Child’s Full Name: *

    Date of Birth *

    Address *



    Check if applicant is under guardianship:
    Check if applicant is adopted:



    Mother's Information



    Check if Deceased:


    Father's Information



    Check if Deceased:


    Legal Guardian Information









    Educational Information


    Has this child received any special education tutoring?

    YesNo


    School(s) of Attendance:




    How did you hear about Lake Michigan Academy? *


    Have you heard of Lake Michigan Academy before this referral?


    Medical History

    Does this child have a history of speech problems or other developmental delays?

    YesNo


    Has your child received speech therapy?

    YesNo




    Is your child currently receiving any medication?

    YesNo


    Behavioral History

    Is there any history of behavioral difficulty, either in relationship to family, peers, or in academic settings?

    YesNo


    Has your child been convicted of any juvenile criminal behavior?

    YesNo


    Parents Perceptions










    Lake Michigan Academy Student Questionnaire


    Date of Birth *




    Have you thought about what you want to do after high school?

    YesNo





    Just give us a call at 616-464-3330 and schedule a personal tour. During the academic year and our summer program, you and your family will have an opportunity to meet our students and teachers. Hear their stories and find out why they love LMA.

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