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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?


    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?


    Has your child received speech therapy?


    Is your child currently receiving any medication?


    Behavioral History

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


    Has your child been convicted of any juvenile criminal behavior?


    Parents Perceptions

    Lake Michigan Academy Student Questionnaire

    Date of Birth *

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


    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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