Academy Application Form Student InformationStudent Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email(Required) Birthdate(Required) MM slash DD slash YYYY Current Grade(Required) Gender(Required) School Information and Reason for RequestResident School (school area you recide in)(Required) School Currently Attending(Required) Are siblings of the student currently attending STEM Academy?(Required) Yes No If so, what are their names?(Required) Does the student receive special education services?(Required) Yes No What special education services is your student receiving?(Required) Does the student receive EL services?(Required) Yes No Please let us know why you are choosing to apply to STEM(Required)By typing your name and date below, you are providing a electronic signature.Parent/Guardian Name(Required) First Last Date Signed(Required) MM slash DD slash YYYY
