Scholar’s name:          Birth date:  //

Home address:         Race:   Select African American American Indian Asian Caucasian Hispanic

City:       Zip code:  

Scholar’s current school:  

Select term for admittance consideration: If earlier than fall of 2011 please use our traditional registration option:    Select Fall of 2012 Fall of 2013 Fall of 2014 Fall of 2015 Fall of 2016 Fall of 2017 Fall of 2018 Fall of 2019 Fall of 2020 Fall of 2021 Fall of 2022 Fall of 2023 Fall of 2024

Grade level for admittance term:    Select 8th 9th 10th 11th 12th |

Have you ever been expelled from another school?    Select Yes No

If yes, which one?  

Has applicant ever skipped a grade?    Select Yes No

Has applicant ever repeated a grade?    Select Yes No

Applying parent/Legal guardian name:  

Home# ()  Cell# ()

Valid e-mail address:  

If Applicable:
Spouse/Legal guardian name:  

Valid e-mail address:  

By submitting this application, I affirm to the best of my knowledge all information contained herein is complete and accurate.  I fully understand any false information, omissions or misrepresentations of facts may result in rejection of this application and/or future dismissal of the applicant.

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