Application Form
Please Note
In order for your application to be considered complete, we need to receive your transcripts and recommendation letters. See below for details.
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Student Applicant Information
The following questions are intended to be completed by the student applicant.
Name Student Wants to Use for School Records
*
First Name
Middle Name
Last Name
Name Student Wants To Be Called At School
*
Date of Birth
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
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1987
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1982
1981
1980
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1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Pronouns
(ex: they/them, he/him, she/her, she/they, xe/xem, xe/xir, any, none, ask me etc.)
Student’s Email
example@example.com
Is there anything else we should know about your child's pronouns?
Ethnicity
Hispanic or Latino
Not Hispanic or Latino
Race
American Indian, Indigenous, Native American
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Multi-Racial
Other
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
First/native language:
*
Please Select
Arabic
Chinese
English
French
German
Italian
Japanese
Korean
Russian
Spanish
Vietnamese
Other
Other languages:
Please Select
Arabic
Chinese
English
French
German
Italian
Japanese
Korean
Russian
Spanish
Vietnamese
Other
Current grade:
*
School Year Applying for:
*
School Information
Current School Name:
*
Current School Type:
*
Public, private, homeschooled, etc.
What grades did you attend at your current school (check all that apply):
PK
K
1
2
3
4
5
6
7
8
School Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
School Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Principal/Head of School or Counselor Name
First Name
Last Name
School Contact's Email
example@example.com
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Parent/Caregiver Information
The following question are to be complete by the parent(s)/guardian(s) of the student applicant. Only one parent/guardian is required to fill out this section. Please note that if you wish to apply for more than one student, you must submit a form for each child.
Parent/Caregiver Name (1)
*
Prefix
First Name
Last Name
Relationship to Student
*
First/native language:
*
Please Select
Arabic
Chinese
English
French
German
Italian
Japanese
Korean
Russian
Spanish
Vietnamese
Other
Other languages:
Please Select
Arabic
Chinese
English
French
German
Italian
Japanese
Korean
Russian
Spanish
Vietnamese
Other
Pronouns:
(ex: they/them, he/him, she/her, she/they, xe/xem, xe/xir, any, none, ask me, etc.)
Ethnicity
Hispanic or Latino
Not Hispanic or Latino
Race
American Indian, Indigenous, Native American
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Multi-Racial
Other
Parent/Caregiver Address (1)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Caregiver Email (1)
*
example@example.com
Primary phone number (1)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Does this person have custody?
Yes
No
Other
Is this person employed?
Yes
No
Other
Occupation / Title:
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Highest Level of Education:
Some high school, no diploma
High school graduate
Some college, no degree
Trade, technical or vocational training
Associate degree
Bachelor's degree
Master's degree
Doctorate degree
Other
College Attended:
Secondary/High School Attended:
Parent/Caregiver Name (2)
Prefix
First Name
Last Name
Relationship to Student
Is this person living?
Yes
No
First/native language:
Please Select
Arabic
Chinese
English
French
German
Italian
Japanese
Korean
Russian
Spanish
Vietnamese
Other
Other languages:
Please Select
Arabic
Chinese
English
French
German
Italian
Japanese
Korean
Russian
Spanish
Vietnamese
Other
Pronouns:
(ex: they/them, he/him, she/her, she/they, xe/xem, xe/xir, any, none, ask me etc.)
Ethnicity
Hispanic or Latino
Not Hispanic or Latino
Race
American Indian, Indigenous, Native American
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Multi-Racial
Other
Parent/Caregiver Address (2)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Caregiver Email (2)
example@example.com
Primary Phone Number (2)
Please enter a valid phone number.
Format: (000) 000-0000.
Does this person have custody?
Yes
No
Other
Is this person employed?
Yes
No
Other
Occupation / Title:
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Highest Level of Education:
Some high school, no diploma
High school graduate
Some college, no degree
Trade, technical or vocational training
Associate degree
Bachelor's degree
Master's degree
Doctorate degree
Other
College Attended:
Secondary/High School Attended:
Please list Additional Parents/Caregivers and their relationship to the Student:
Please state the marital or relationship status between parents/caregivers:
(Married, Civil Union/Domestic Partner, No Marital Relationship, Separated, Divorced, Widowed, Other)
Siblings
Please list the full name, age and grade in school for each sibling:
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What activities are of interest to the applicant.
Athletics (Sports and Recreation)
Rows
Currently Participates
Has Tried
Interested In Trying
Uninterested
Baseball
Basketball
Cross Country
Field Hockey
Football
Gymnastics
Ice Hockey
Lacrosse
Soccer
Softball
Swimming/Diving
Tennis
Volleyball
Other:
Please list additional Sports/Recreation that you are involved in
Music
Rows
Currently Participates
Has Tried
Interested In Trying
Uninterested
Choir
Orchestra
Band
Jazz Band
Please list Instruments that you play and for how long:
Visual/Performing Arts:
Rows
Currently Participates
Has Tried
Interested In Trying
Uninterested
Computer graphics
Dance
Drama / Theatre
Painting / Drawing
Photography
Pottery
Videography
Woodworking
Needle Arts
Other:
Please list any additional Visual/Performing Arts you are involved in.
Clubs/Alliances/Affinities:
Rows
Currently Participates
Has Tried
Interested In Trying
Uninterested
Book Club
Robotics
Debate Club
School Newspaper
Yearbook
Mathletes
Chess Club
GSA
Student Alliance Group
Student Affinity Groups
Other:
Please list any additional Clubs/Alliances/Affinities you are interested in or taken part in.
Community service or volunteer work:
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Student Short Essays:
Note to student: This section of the application should be completed by the student. Please respond to any THREE of the four prompts using about 200-250 words per response. 1. Aside from books or articles assigned from school, what book(s), article(s), podcast(s) and or documentary(s) have you most enjoyed in the past year and why? 2. Describe a challenge that had a meaningful impact on you. What did it take to face the challenge and what did you learn from the experience? 3. Each person has unique characteristics that define who they are. Choose three words that best describe you as a person, and explain how they represent you. 4. Students at PROUD may have a multitude of different ethnicities, religions, and cultures; all identities/expressions are important to PROUD Academy. How do you envision contributing to the PROUD Academy community and the experience of your new friends, considering the broad spectrum of identities? What can PROUD Academy do to support your identities?
Prompt 1:
0/300
Prompt 2:
0/250
Prompt 3:
0/250
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Parent Reflections
Please check the box that best reflects the skill level of your child in each of the categories. You may read about the skills below the chart. Skill Levels Definitions: ~ Demonstrating: Clear understanding and use of this skill. ~ Developing: This skill is present and still developing. ~ Emerging: Starting to show signs of this skill.
Rows
Demonstrating
Developing
Emerging
No basis for judgement
Initiative
Intellectual Engagement
Open-mindedness
Resilience
Self-control
Social awareness
Teamwork
What are your hopes for your child in their PROUD Academy experience? (200-250 words)
0/250
Describe an experience that posed a significant challenge for your child. How did your child respond to that challenge? (200-250 words)
0/250
Has your child been the subject of school disciplinary action? If so what were the circumstances that led to that and what interventions were or would have been helpful in the situation, for your child?
0/250
Is there anything specific about the sequencing of your child's schooling that you would like to share? (such as skipped or repeated a year)
No
Yes
If yes, please describe:
Transcripts
Please upload the last 2 years of transcripts or email them to info@proudacademyct.org (Subject: Student Transcripts)
Transcripts:
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Recommendation Letters
We would like 3 recommendation letter and the preference is: 1 recommendation letter from a counselor (school or private) or Principal, 1 recommendation letter from a teacher, and 1 recommendation letter from a community member of your choice (ex: coach, scout leader, mentor). Please have your contacts email their recommendation letters to info@proudacademyct.org (Subject: Student's Name and Recommendation Letter)
Thank you for completing the application!
Before signing and submitting this form, please take a moment to review your answers.
Name of Parent/Caregiver completing application:
Signature
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