Centerpoint Academy
Pre-enrollment Form
Please fill in as much of the information as you can and an academic advisor will call you shortly.  If you need help or want immediate attention please call us directly at: 800-863-1474

Personal Information
Your Full Name * Age Sex
Email Address * Home Phone *
Shipping Address Cell Phone 
Work Phone 
City   State   Zip

Previously Attended School(s) Information
Last Grade Completed 
School Name 
Address 
City    State   Zip
School Name 
Address 
City    State   Zip

Best time to call

Name of Recruiter If Applicable

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