Student Information

Student First Name *

Student Last Name *

Gender (select an option)*
---MaleFemaleOther

Date of Birth (YYYY/MM/DD/) *

Entering Year (select an option) *
---2019-20202020-20212021-20222022-20232023-20242024-20252025-20262026-20272027-20282028-20292029-2030

Entering Grade (select an option) *
---Pre-KindergartenJr KindergartenSr Kindergarten1st2nd3rd4th5th6th7th8th9th10th11th12th

Please enter information regarding the parents of the applicant below.

Parent First Name *

Parent Last Name *

Relationship to Student (select an option) *
---MotherFatherStep-MotherStep-FatherGrandparentGuardianSelfOther

Email *

If you are an agent applying on behalf of a student, please fill in the appropriate information below.

Agent Name

Agent Email

Agent Phone

Agency Name