Please enable JavaScript in your browser to complete this form. - Step 1 of 3Contact Name *FirstLastRelationship *Child's Name *FirstLastPhone Number *Email *Age *Current Grade Level *CountyApplingAtkinsonBaconBakerBaldwinBanksBarrowBartowBen HillBerrienBibbBleckleyBrantleyBrooksBryanBullochBurkeButtsCalhounCamdenCandlerCarrollCatoosaCharltonChathamChattahoocheeChattoogaCherokeeClarkeClayClaytonClinchCobbCoffeeColquittColumbiaCookCowetaCrawfordCrispDadeDawsonDecaturDeKalbDodgeDoolyDoughertyDouglasEarlyEcholsEffinghamElbertEmanuelEvansFanninFayetteFloydForsythFranklinFultonGilmerGlascockGlynnGordonGradyGreeneGwinnettHabershamHallHancockHaralsonHarrisHartHeardHenryHoustonIrwinJacksonJasperJeff DavisJeffersonJenkinsJohnsonJonesLamarLanierLaurensLeeLibertyLincolnLongLowndesLumpkinMaconMadisonMarionMcDuffieMcIntoshMeriwetherMillerMitchellMonroeMontgomeryMorganMurrayMuscogeeNewtonOconeeOglethorpePauldingPeachPickensPiercePikePolkPulaskiPutnamQuitmanRabunRandolphRichmondRockdaleSchleyScrevenSeminoleSpaldingStephensStewartSumterTalbotTaliaferroTattnallTaylorTelfairTerrellThomasTiftToombsTownsTreutlenTroupTurnerTwiggsUnionUpsonWalkerWaltonWareWarrenWashingtonWayneWebsterWheelerWhiteWhitfieldWilcoxWilkesWilkinsonWorthDate of Birth *Previous or Current School Attended(ing)List the current or previously attended school of the student.Is child in a Special Need Scholarship Program/ IEP *YesNoWhen Would You Like Your Child to Attend? *20242025NextAdditional QuestionsDoes He Currently Take Any Medication *YesNoPlease List the Medication / ReasonAre Both the Mother & Father Involved?YesNoPlease List All Parties Actively InvolvedDo You Need Your Child to Board In Order to Attend?YesNoCommute, Out of State, Military (8th grade and below ONLY)Please ExplainIn Your Opinion, What is the Worst Scenario You've Encountered With Your Child?What Are His Greatest Strengths/Characteristics? Things He Loves?NextHow Did You Hear About Us? *Has the Student Attended Miller’s Military Academy in the Past? *YesNoAre you a Veteran? *YesNoSubmit
