Enrollment Form For E-STEM Middle School West Campus

Enrollment Qualifications

Dear Parent (s) and Applicant:

Thank you for your interest in E-STEM Academy, Inc. Please fill out thiis application completely. Falsification, misrepresentation, or any omissions nay disqualify your application. Information you supply may not be given to any other companies for solicitation purposes. Please print a copy of the application for your records before submitting.

Students must exhibit an interest in one or more of the STEM disciplines and must demonstrate a willingness to commit to the self-discipline required by a rigorous academic program. In addition, parents and/or guardians must participate in the application interview process.

You can download the Application Form Here.

Date Of Application / MM / DD YYYY
Required
Students Name First Last
Required
Date of Birth / MM / DD YYYY
Required
Email

Required
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Required
Home Phone - (###) - ### ####
Required
Cell Phone - (###) - ### ####
Guardians Name First Last
Required
Guardians Relation

Required
Guardians E-Mail

Required
Current School

Required
Current District

Required
Current Grade

Required
Criminal History

Required
If you said yes to the above please explain.

Copies of the following must be presented at the orientation:
Previous years FINAL report card (2010/2011)
Current picture of student (wallet size)
Birth certificate
Social Security (if applicable)

Energized For STEM Academy, Inc.

Enrollment Form For E-STEM Middle School West Campus

Enrollment Qualifications