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Ready to Apply?

Complete the form below if you are ready to officially inquire about admission for your children.


Admissions Office Hours

Monday - Friday
8:00am - 3:00pmĀ 


Kori Shellard, RegistarĀ 
541-637-7500
kshellard@genevaroseburg


Parent/Guardian Information
First Name *
Last Name *
First Name *
Last Name *
Home Address
Country
Address Line 1 *
City *
State/Province *
Postal Code *
Preferred Channel of Communication
Do you attend church?
Student 1
First Name *
Last Name *
Gender
School Year
Student 2 (if applicable)
First Name
Last Name
Gender
School Year
Student 3 (if applicable)
First Name
Last Name
Gender
Grade Level of Interest
School Year
Student 4 (if applicable)
First Name
Last Name
Gender
Grade Level of Interest
School Year
Comments/Additional Information (optional)
How did you hear about Geneva Academy?