The Myrtle Beach STEM Academy Student Application Form

The Myrtle Beach STEM Academy Student Application Form
Academic Year
Grade Applying For
STUDENT INFORMATION
Student Full Name
Date of Birth

MonthDayYear
Date
Current School
Current Grade Level
*Middle School Our school offers STEM-focused majors to help students prepare for future careers. Please select your 1st Choice for your pathway.
*Middle School Our school offers STEM-focused majors to help students prepare for future careers. Please select your 2nd Choice for your pathway.
*Middle School Our school offers STEM-focused majors to help students prepare for future careers. Please select your 3rd Choice for your pathway.
*Middle School and High School Preferred Learning Style or Work Environment. How do you learn best? (Choose all that apply)
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Street Address
City
State
ZIP Code
PARENT/GUARDIAN INFORMATION
Full Name
Relationship to Student
Phone Number
Format: (000) 000-0000.
Email Address
example@example.com
Parent/Guardian 2 (if applicable):
Full Name
Relationship to Student
Phone Number
Format: (000) 000-0000.
Email Address
example@example.com
Has your child previously applied to this school?
If yes what year
Has your child ever been suspended or expelled from any school(s)
If yes, please explain
Please briefly tell us why you want your child to attend our charter school and how you believe they would benefit from our learning environment
How did you hear about us?
REQUIRED DOCUMENTS (Submit when accepted)

Copy of Birth Certificate

Proof of Residency (utility bill, lease, etc)

Most Recent Report Card

IEP or 504 Plan (if applicable)
Please read and acknowledge the following

Submission of this application does not guarantee enrollment. Enrollment is offered based on seats available. If more applications are received than seats available for any particular grade, a lottery will be held to determine students offered a seat. If a seat is available, the family will receive notification and an enrollment packet to complete to accept the seat. All other applications will be placed on a waitlist. All applications are processed in accordance with the Charter Schools Act of 1996, as amended, and other applicable lawMyrtle Beach STEM Academy does not discriminate on the basis of race, creed, color, disability, sex, national origin, religion, pregnancy, or any other protected characteristic, as may be required by federal and state law in its admissions or any other school-related programs. We provide equal access to all designated youth serving organizations. Non-discrimination inquiries should be directed to Jayson Powers via Email - jpowers@myrtlebeachstemacademy.com Principal Title IX inquiries should be directed to the Myrtle Beach STEM Academy Title IX Coordinator - Jayson PowersEmail: jpowers@myrtlebeachstemacademy.com
I have read and understand the legal and enrollment disclaimer above.

By Submitting this Application:You are applying for the lottery into Myrtle Beach STEM Academy for the student’s placement for the grade indicated above. If there are more applications than seats available, your student will be assigned a number and entered into a lottery to determine placement in the school or wait list. If a seat is available for your student, you will receive notification and an enrollment packet with next steps for accepting the seat and enrolling
ParentGuardian Signature
Date

MonthDayYear
Date
Should be Empty:

The Myrtle Beach STEM Academy Student Application Form

STUDENT INFORMATION

HOME ADDRESS

PARENT/GUARDIAN INFORMATION