The Academy Student Application

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Students who are interested in interviewing to attend The Academy will need to complete this application. If selected for an interview the applicant will receive a phone call from The Academy to schedule an interview.

This application is for high school students applying to The Academy. Students in middle school and want to apply to the PASS program need to apply at their home school.

NOTE: Students under the age of 18 will need to be accompanied by a parent or guardian to the interview.

Today's Date *

YYYY

Last Name *

First Name *

Current age? *

What grade are you in? *

Date of Birth *

YYYY

Address: Street, Town, ZIP *

Last School Attended *

Charlotte High School

Lemon Bay High School

Port Charlotte High School

Other: Answer the question below.

Other school(s) attended outside of CCPS. Please provide the name of school, city, county, and the state where the school is located.

Are you ESE or have a 504 plan? *

ESE

504

No I am not ESE or have a 504 plan.

Not Sure

Have you ever been retained? If so, what grade? *

How many high school credits do you have? *

What is your current grade point average (GPA)? *

Are you seeking an underage GED waiver? *

Yes

Why do you want to attend The Academy? *

Provide two goals you have for this school year? *

What are you interested in doing after high school? *

College

Vocational (Trade)

Military

Workforce

Are you a pregnant or a teen parent? *

Yes

Have you ever been arrested and/or charged with a juvenile/adult crime?*Florida Statue 1006.17 requires the disclosure of previous school expulsions, arrests resulting in a charge, and Juvenile Justice actions. Failure to provide accurate information can result in denial of educational participation. *

Yes

If yes, complete the question below.

Arrest Infomation: Date, Charge, and Reason.

Have you ever been suspended or expelled from school? *

Yes

If yes, answer the next question.

Reason for suspension and/or expulsion?

Student Cell Phone Number *

Parent(s) or Guardian(s) Name *

Parent(s) or Guardian(s) Cell Number (Or best number to be reached) *

Parent or Guardian Email *

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