Enrollment Application

Thank you so much for considering Achievement Center of Texas for your child or ward.

We offer ISS (formerly Day Habilitation) for people 13 years or older. At this time, we cannot accept students into our program that are Level of Need (LON) 9 or have dual diagnoses with a mental illness (such as bipolar disorder, schizophrenia, etc.).

After you fill out this form, pay the $35 application fee and click “submit,” you will receive an email with a link to our printable application for you to complete and turn in.

NOTE: Paying the application fee and filling out the application does not secure you a spot in our program. We have limited spots available. Filling out the application does, however, put you on the waiting list, unless we determine that your child’s needs cannot be best met at our center.

"*" indicates required fields

Your Name*

Please submit your name as the parent or ward of the prospective student.

First Last

Prospective Student Name*

Please submit the name of your child or ward.

First Last

Cell Phone*

Please provide your cell phone number so we can contact you.

Is it okay to text your cell phone?*

Yes

Email*

Please provide the email address for the contact person. We will use this email address to communicate with you about your registration. Please check the box below if we can use this email address for other projects.

Future Email Use Consent*

We would like to send occasional emails about volunteer and other activities. We do not share, sell or lease your information. You will always be given the option to opt out of future emails. If you’re already on our list nothing will change.

Yes

Application Fee*

If you have another child or ward you would like to complete an application for, please start the process over after clicking “submit.”

Price:

Total

Credit Card

Card Details

Cardholder Name

Name

This field is for validation purposes and should be left unchanged.