Hybrid & Ground Community Enrollment

Complete Application Submit student, guardian, medical, and academic information.

Admissions Review Every application is reviewed before final enrollment approval.

Hybrid Placement Approved students enter the applicable digital, physical, or blended experience.

Student Information

Basic identity, grade, and previous school information.

First Name *

Middle Name

Last Name *

Suffix

Preferred Name

Date of Birth *

Gender

Student Email Address * Used for the student learning portal.

Grade Level *

Graduation Year

Race / Ethnicity

Nationality

Home Language

Enrollment Type

Previous School Information

Previous School Name

School Location

Dates Attended

Reason for Leaving Previous School

Guardian Information

Primary household, secondary guardian, and emergency contacts.

Primary Guardian

Full Name *

Relationship *

Preferred Language

Cell Phone *

Home Phone

Email Address *

Secondary Guardian — Optional

Full Name

Relationship

Custody Information

Cell Phone

Work Phone

Email Address

Emergency Contact

Emergency Contact Name *

Relationship *

Phone Number *

Health & Medical Information

Information needed for student safety during physical participation.

Primary Physician Name

Physician Phone Number

Health Insurance Provider

Policy Number

Group Number

Allergies

Medical Conditions

Current Medications

Emergency Medical Treatment Authorization * This authorization may be used if emergency care is required and a parent or guardian cannot be reached immediately.

Academic Information

Support services and language-learning information.

Special Education Services

English Language Learner Status

Agreement & Submission

Review the application statement before submitting.

I confirm that the information provided in this application is accurate and complete. I understand that submission of this application does not automatically guarantee admission or placement and that DBM Learning Academy may request additional records, documents, meetings, or information during the admissions process.

After submission:

Your application enters admissions review.
Temporary login credentials are sent by email.
DBM may request additional information.
You will be contacted regarding the enrollment decision and next steps.
Approved students receive the applicable physical, digital, community-based, or hybrid learning access.