Saturday Academy

Application


SATURDAY ACADEMY APPLICATION
• 2017-2018 •

PERSONAL INFORMATION:

First Name:*
Last Name:*
Middle Name/Initial:
Address:*
Telephone:*
-
E-mail:*
Date of birth (mm/dd/yy}:
Gender:
Are you Hispanic/Latino?

Which of the following do you consider to be your racial background? Please check all races that apply:

EDUCATION INFORMATION:

Name of school:
Grade:
Is student taking, or previously taken: Biology, Chemistry, Algebra?
If yes, please specify

PARENT/GUARDIAN INFORMATION AND CONSENT:

Parent/Guardian Name(s):
Address (if different from yours)
Per the above, are you the _____ (please select one)
Parent/Guardian telephone:*
-
Where does your Parent or Guardian work?

SUPPLEMENTAL QUESTION:

Will you participate in tutoring from 9:00 a.m. to 10:00 a.m.?