Miami Union Academy

Online Application

To begin the application process, please complete the secure form below. Once we’ve received your application, we will review it and contact you.

All fields with an * are required.

Applicant

First name *

Middle name

Last name *

Permanent Address: Street*

City *

State *

Zip/postal code *

Country *

Phone *

Gender *
Female Male

Date of birth *

Current age *

Place of birth (city, state, country) *

Country of Citizenship *

Not a US Citizen? What is your legal status? *
Permenant Resident Visa

Denomination *

Baptized?
Yes No

Church *

Conference

Enrollment

The student will be entering grade? *

Were you recruited by a MUA student? Who?

Previous school name

School phone number

Year attended

Street address

City

State

Zip/postal code

NOTE: Grade placement of students is tentative until official transcripts from last school are reviewed.

Discipline History

Have you ever been -
Asked to Withdraw Suspended Expelled No Major Discipline Action

Explain reason for discipline (if applicable)

Medical Information

Health
Good Fair Poor

Do you have any physical condition that may limit or interfere with learning in any capacity?
Easy Fatigue Emotional/Mental Problems Hearing Impaired Nervousness Vision Problems Heart Condition Asthma Other

If other, what is it?

List any prescription medication taken regularly.

Person To Receive Information

Emergency Contacts

Name

Relationship

Phone

Name

Relationship

Phone

Name

Relationship

Phone

Agreement

By submitting this form you are making an agreement by and between Miami Union Academy, student and parent/guardian, in the event that Miami Union Academy agrees to accept this student, we understand it will be under the following conditions:

Student and parent/guardian acknowledge that they are responsible to receive and read the school handbook, and
that they take responsibility to support all terms and conditions if said information included herein are correct and
complete.
Student and parent/guardian acknowledge that all photographs taken for the school may be included in promotional material for the school.
I, the undersigned parent/guardian, accept financial responsibility for this student, and do understand and agree
that the student will not be permitted to take exams, and will not be able to participate in graduation exercises until
the student’s account is current or satisfactory financial arrangements have been made.

By checking this box I agree to the terms of this application.

Powered by Solo Media Works