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Request Information

Thank you for your interest in Upland Christian Academy.

Please fill out the inquiry form below and our Admissions Office will contact you and provide the information you have requested.

* Indicates a required field.

  • Parent/Guardian Information
  • *First Parent/Guardian
  • Salutation *
    First Name *
    Middle Name
    Last Name *
  • Email Address *
    Gender
    Male    Female
  • Cell Phone
    (Ex: 999-999-9999)
  • Second Parent/Guardian
  • Salutation
    First Name
    Middle Name
    Last Name
  • Email Address
    Gender
    Male    Female
  • Cell Phone
    (Ex: 999-999-9999)
  • How Did You Hear About Us? *
    Details:
  • Home Phone *
    (Ex: 999-999-9999)
  • Street Address *
  • City *
  • Country *
  • State *
  • Zip *
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate
    (mm/dd/yyyy)
    Gender
    Male    Female
  • Grade Level of Interest *
    School Year *
  • Student Interests
    Academics
    Athletics
    Arts
  • Current School
  •  
  • Is There Another Student? Yes No
  •  
  • Parent/Guardian Notes
  •