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Delta West Academy

Where bright futures begin!

Application Form

We look forward to receiving your child's application and discussing the difference that Delta West Academy can make in your child's life.

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Application for Admission
Email address to send automated reply to: (required)

Student Information
Student's Legal Name: Last:
Given: Middle:
Home Address:
Postal Code:
Home Phone: Home Fax:
Home E-mail:
Date of Birth: Sex: M F
Citizenship:


Parent/Guardian Information

The following information should reflect the immediate family environment that the student resides in.
Information for:
Father
Step-Father
Guardian		 Last Name:
Given Name:
Company Name: Position:
Bus. Phone: Cell Phone: Bus. E-mail:

Information for:
Mother
Step-Mother
Guardian		 Last Name:
Given Name:
Company Name: Position:
Bus. Phone: Cell Phone: Bus. E-mail:
Specify court ordered custody arrangements and forward a copy of the court order to the school when applying.

Siblings:
(Names, ages and current schools)

If you wish to declare that you are an Aboriginal person, please specify: Status Indian/First Nations
Non-Status Indian/First Nations
Metis
Inuit
Alberta Education is collecting this personal information pursuant to section 33(c) of the FOIP Act as the information relates directly to and is necessary to meet its mandate and responsibilities to measure the system effectiveness over time and develop policies, programs and services to improve Aboriginal learner success. Pursuant to section 7 and 8 of the PIPA Act accredited private schools in Alberta are collecting this information for the same above purposes. This information will also be used to deterine the provincial First Nations, Metis ann Inuit funding allocation provided to school authorities. For further information or if you have questions regarding the collection activity, please contact the office of the Director, Aboriginal Policy, Policy Sector, Information and Strategic Services Division, Alberta Education, 10155-102 Street, Edmonton AB, T5J 4L5, 780-427-8501 or the principal of Delta West Academy at 403-290-0767.  By declaring that I am an aboriginal person, I consent to the collection, use and disclosure of this information by the private school for the purposes stated above.



Medical Information
Emergency Contact: Name:
Relationship:
Home Ph.: Bus Ph.: Cell Ph.:
Please specify any serious medical conditions (diabetes, asthma, etc.), life-threatening allergies (peanuts, insect stings, shellfish, etc.) and if the student carries an Epi Pack.


School Information
Applying for grade: Year being applied for:
Present Grade: Last Grade Completed:
Current School:
Phone:
Type of School: Public
Separate
Private
Charter
Other:
School History:
(please specify school, years and grades)
Board to which taxes are directed: Calgary Public
Calgary Catholic
Rockyview
Other:
Has the student repeated any grade? If so what grade:

Please specify any significant learning diagnosis (gifted, disability, ADD, etc), program modification, resource room support or IPP that has applied to the student in previous years.
Please forward any professional educational or psychological testing/assessment
Specify any disciplinary issues (ie. suspensions, etc).

Please indicate extra-curricular school activities that the student participates in or has participated in previously.

Please indicate regular activities that the student participates in outside of school. (Lessons, clubs, teams, volunteer work, etc.)



* Note: Admission is contingent on final interview with Director of Admissions.


The information collected on this application form is protected under Personal Information Protection Act (PIPA). If the applicant is unsuccessful, this form along with any accompanying documents, test results and interview notes will be disposed of in a confidential manner. If the applicant is successful and enrolled at Delta West Academy, this information will be confidentially managed by the school.