RPA Interest Form | Rising Phoenix Academy

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We love that you're interested in our school!

Tell us more about your family, especially your

potential RPA scholar.

Potential Scholar's First Name

Potential Scholar's Last Name

School Currently Attending

Potential Scholar's Grade for the 2026-2027 Academic Year

Potential Scholar's Date of Birth * required

School Year Interested In (e.g., 2026–2027)

Does your child have any special learning needs or accommodations? *

Yes

I am not sure

Parent/Guardian's Full Name

Mailing Address

City

State

Postal / Zip code

Phone

Preferred method of contact?

Phone Call

Text

What is your primary reason for submitting this interest form? (Select all that apply) * Required

Enrolling my child (2026-2027 Academic Year)

Enrolling my child in the future

Learning more about the school

Looking for tuition and financial aid information

(Optional) Leave us a message...

I understand this is an interest form only and does not guarantee enrollment. I give Rising Phoenix Academy permission to contact me regarding admissions, open houses, and enrollment updates.

Thank you for your interest in Rising Phoenix Academy! We have received your information and will contact you with updates about admissions, enrollment, and upcoming events.

Rising Phoenix Academy

Beloit, WI 53511

info@rpabeloit.com

Tel: 608-713-1913

"Together we rise, thrive, and lead."

What can we help you with?

First name*

Last name*

Phone

Email*

Message

The e⁵ Blueprint™ is an educational framework developed by Rising Phoenix Academy Founder Michelle Hendrix-Nora and Co-Founder Regina D. Hendrix and owned by The e5 Blueprint Institute, LLC. It is implemented by Rising Phoenix Academy under license.

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