North East STEM Academy - Admission Application

Student Information
Student Name*

First Name Middle Name Last Name
Student's Date of Birth*

MonthDay Year
Date
Student's Gender*
Current Grade (Select One)*
Voluntary Information
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. If no SIN exists, one will be generated.
Social Security Number
Student Identification Number
I have another child attending this charter school

YesNo
This is a child of a staff or board member

YesNo
If yes, please enter the name of the students siblings, staff or board member

Parent/Guardian Information
Parent/ Guardian Name*

First Name Last Name
Primary Residence Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
By checking this box, I certify to the best of my knowledge and belief that the information in this application is complete and accurate, 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.*

Certify
This school does not discriminate on the basis of sex, national origin, ethnicity, religion, disability, or academic or athletic ability.
Should be Empty:

North East STEM Academy Admission Application