NESTEM Application Form

NESTEM Academy Application Form
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Current Grade*
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 NNS, please supply the Student Information Number (SIN). If no SIN exists, one will be generated.
Social Security Number
Student Identification Number
I have another child attending this school?*

YesNo
Is this is a child of a staff or board member of Tejano Center for Community Concerns?*

YesNo
Parent/Guardian Information
Parent/Guardian Name*
Primary Residence Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
Phone Number*
By checking this box, I certify to the best of my knowledge and belief that the information in this application in 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:

NESTEM Academy Application Form