Student Registration Form 2021-2022

Jean Massieu Academy
Student Application for Enrollment 2021-2022

All considerations are based upon space and eligibility.
Student Name *

First Name Middle Name Last Name
Student Birth Date *

Month Day Year
Student Gender *
Social Security Number (optional)
Providing a SSN is voluntary and used to match a student's Unique ID through the Texas Student Data System. If you do not wish to supply the SSN, please supply the SIN.
Student Identification Number
If no SIN exists, one will be generated.
Grade Applying for (2021-2022 School Year) *
What school should student attend where he/she resides? *
Parent/Guardian Name *

First Name Last Name
Parent Mobile Number *

Area Code Phone Number
Student Lives With: *
Student Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent E-mail *
example@example.com
Siblings that would like to attend JMA *
Please give name and grade
How did you hear about Jean Massieu Academy?
By clicking Submit Application you certify that to the best of your knowledge and belief the information in this application is complete and accurate. I certify that I am the legal guardian of the child listed above, and I understand that any false information,omission, or misrepresentation of facts may result in the rejection of this application or future dismissal of the applicant.

Jean Massieu Academy does not discriminate on the basis of sex, national origin, ethnicity, religion, disability, or academic or athletic ability.
Should be Empty:

Jean Massieu Academy

Student Application for Enrollment 2021-2022