JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Septima P. Clark Academy Student Application 2020-2021
Please complete to the best of your ability and a member of our staff will contact you to schedule a tour and an interview.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Student Applicant Information
Please complete this section with the applicant's student information.
Student's Full Name
*
Your answer
Date of Birth
*
Your answer
Gender
Male
Female
Other:
Clear selection
Full Mailing Address
*
Your answer
Student Email Address
*
Your answer
Student Phone Number
*
Your answer
Ethnicity
*
Black/African American
White/Caucasian
Hispanic/Latino
Asian/Pacific Islander
Other:
Required
Parent/Guardian Information
Please complete concerning adult support for student applicant
Name(s)
*
Your answer
Address(if different from student)
Your answer
Relationship to Student
*
mother
father
grandparent
Other:
Parent Phone Numbers
*
Your answer
Parent Email Address
*
Your answer
School Information
**general information to be paired with transcripts**
Current Home School
*
Your answer
CCSD Zoned School (if different)
Your answer
Schools Attended (High and Middle)
*
Your answer
Other Information (Special Needs)
*
Existing IEP
504 Plan
BIP Plan
none
Other:
Required
Discipline
*
Prior referral to DAP
Prior Expulsion
Never referred for Expulsion or DAP
Other:
Required
Any friends or relatives currently at Clark?
*
Your answer
Short Answer (please answer in at least 5 sentences)
To be completed by potential student
Why are you interested in attending Clark Academy?
*
Your answer
Describe a time you have had to change in order to be successful.
*
Your answer
Describe a problem (attendance, behavior, academics) in school that you have had in the past and what you can do to make sure that you do not have the same problem at Clark.
*
Your answer
Describe a person you look up to and why.
*
Your answer
Describe yourself to a person who has never met you before.
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Charleston County School District.
Report Abuse
Forms
