Request Information

Thank you for your interest in our school!

If you would like to talk to someone right away please call or text Kimberly Roth at 423-260-9794.

* Indicates a required field.

Parent / Guardian Information
First Parent / Guardian Last Name * First Name * Middle Name Salutation * Email Address * Gender Male Female Work Phone (Ex: 999-999-9999) Cell Phone (Ex: 999-999-9999)	Second Parent / Guardian (leave blank if not applicable) Last Name * First Name * Middle Name Salutation * Email Address * Gender Male Female Work Phone (Ex: 999-999-9999) Cell Phone (Ex: 999-999-9999)

Home Address
Street Address City Country State Zip Home Phone * (Ex: 999-999-9999) How Did You Hear About Us? Details: What is your interest in Highland Academy? Student 1 First Name * Middle Name Last Name * Birthdate (mm/dd/yyyy) Email Address Gender Male Female Grade Level of Interest * School Year * Current School Is There Another Student? Yes No Parent / Guardian Notes