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Application Form

Please complete and submit the application below to be considered for enrollment in our program.

Be sure to review all information for accuracy before submitting. Incomplete or incorrect applications may delay the review process.

If you need assistance at any point, our team is here to help.

📞 Phone: (859) 214-7122
📧 Email: [email protected]

Student Information

Student's Legal First Name *

Student's Legal Last Name *

Middle Name *

Home District for NHA Enrollment *If you do not see your home district, select New Horizons Academy *

Gender *

Date of Birth *

Grade Level *

Student's Current Age *

Social Security Number: Please enter the student's Social Security Number. The Kentucky Department of Education recommends completing this field for all students when information is available. This data matches students for various state and federal scholarships and additional funding purposes for each student.

What academic year are you applying for? *

Preferred Communication *

Address

Student's Primary Address *

City *

State *

ZIP *

Student's Email *

Student Phone *

Race *

Primary Parent/Guardian Information (With Whom the Student Resides)

Relationship *

First Name *

Last Name *

Primary Email *

Primary Phone *

Alternate Parent/Guardian Information

Relationship

First Name

Last Name

Primary Email

Primary Phone

Additional Information

Previous Education Provider *

Reason for Virtual Learning

Educational Support Services *

For new students: Please provide the name of homeschool curriculum used if the student was homeschooled last year apart from NHA.

Does the student reside with the second guardian? *

Please provide a non-resident contact who may be contacted in case of emergency or immediate need. *

Phone number for non-resident contact *