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Request Information

Thank you for your interest in Eastbrook Academy!

Please fill out the form below and our Admissions Office will provide the information you desire.

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Cell Phone
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Cell Phone
Home Address
  • Street Address
  • City
  • Country
  • State
  • Zip
  • Home Phone *
  • How Did You Hear About Us? *
    Details:

  • I would like more information on Scholarships and Financial Aid.
    Yes   No

  • I will be applying for a tuition voucher through the Private School Choice Program.

  • I am a member/attendee of Eastbrook Church?
    * Yes   No
  •  
  • Student 1
  • First Name *
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
    Gender
  • Grade Level of Interest *
    School Year *
  • Current School
    Other:

  • I am interested in taking a tour.
    Yes   No
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •