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Request Information

We are excited to learn of your interest in our school.  Thank you!

Please fill out the form below and our Office Staff will contact you and provide the information you desire.

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Cell Phone *
Home Address
  • Street Address *
  • City *
  • Country *
  • State
    *
  • Zip
    *
  • Home Phone
  • How did you hear about CCA?
    Details:

  • Have you previously made inquiry at Cortland Christian Academy?
    Yes   No

  • Besides your request for information, which of the following would also be of interest to you? (Check all that apply)
  •  
  • Student 1
  • First Name *
    Last Name *
  • Gender *
  • Grade Level of Interest *
    School Year *
  • Current School

  • Does your child have special needs that require academic accommodations?  (IEP, 504 Plan, etc.)
    * Yes   No

  • If yes, briefly explain.
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •