PINEVALE STEM ACADEMY APPLICATION

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Pinevale Elementary is excited to offer students the opportunity to apply to be a part of the inaugural Pinevale STEM Academy for 5th graders for the upcoming school year.

An application must be completed per student and all information must be provided as requested. Completion of this application does not guarantee admission into the Pinevale STEM Academy. Providing false information on this application will lead to ineligibility for consideration for placement in the Pinevale STEM Academy. Parent(s) or Guardian(s) must provide verification that the applicant meets registration requirements.

Email *

I am the legal parent or guardian of the student applying to Pinevale STEM Academy. *

Yes

Student First Name *

Student Middle Name *

Student Last Name *

Student Home Address *

City *

State/Province *

Zip Code *

Student Number: *

Student Birth Date: Month/ Day/ Year *

Does your child meet registration requirements to attend Pinevale STEM Academy? *

Yes

Name of Parent/Legal Guardian First Name *

Name of Parent/Legal Guardian Last Name *

Parent Home Address *

City *

State/Province *

Zip Code *

Primary Phone Number: *

Secondary Phone Number: *

E-mail Address: *

I have read, understand and agree to the following: *

1. Eligibility requirements

2. Submission of a complete application

3. Attend mandatory acceptance/ contract meeting

Required

Signature: (Type your full name and email address). *

Send me a copy of my responses.

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