Elementary Program Application: Winter 2025

Elementary Program Application: Winter Session

Please include a copy of the student's most recent report card along with the tuition payment or application for financial aid. Please do not send test scores. NOTE: Students who participated in the fall session do not need to submit another report card. Families will receive a full refund if a student is not admitted.
Student's Name*

First NameLast Name
Preferred Name (If Different)
Pronouns Used*
he/him/his, she/her/hers, they/them/theirs, etc.
Date Of Birth*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student's School*
Name of School
Current Grade Level*
Has The Student Attended MITY Previously?*
Upload the student's most recent report card here. Do not send test scores. You can also email it to info@mity.org.

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Parent / Caregiver Information
Parent/Guardian 1*

First NameLast Name
Email*
example@example.com
Cell Phone Number*
Please enter a valid phone number.
Parent/Guardian 2

First NameLast Name
Parent/Guardian 2 Email
example@example.com
Parent/Guardian 2 Cell Phone
Please enter a valid phone number.
How Did You Learn About MITY?*

Class Selection: Grades 1 and 2

Students take two classes each Saturday. When a class becomes full, it is labeled "Waitlist". Students in grades 1 and 2 are together and students in grades 3 and 4 are together. Please select a first choice and a second choice for each period. If your first choice is full, you will be enrolled in your second choice and placed on the waitlist for your first choice.
Period 1: 1st Choice
Period 2: 1st Choice
Period 1: 2nd Choice
Period 2: 2nd Choice

Class Selection: Grades 3 and 4

Students take two classes each Saturday. When a class becomes full, it is labeled "Waitlist". Students in grades 1 and 2 are together and students in grades 3 and 4 are together. Please select a first choice and a second choice for each period. If your first choice is full, you will be enrolled in your second choice and placed on the waitlist for your first choice.
Period 1: 1st Choice
Period 2: 1st Choice
Period 1: 2nd Choice
Period 2: 2nd Choice

Health Information
Emergency Contact (Must be different than parent(s) / guardians(s) listed above.)*

First NameLast Name
Emergency Contact Cell Number*
Please enter a valid phone number.
If the student has been diagnosed with ADHD, anxiety, asthma, ASD, depression, diabetes, severe allergies, or anything else that the MITY staff should know about, please explain.
If the student has any specific needs or accommodations for behavioral, physical, emotional and/or educational challenges, please explain. (This will NOT impact their eligibility for the program; it helps ensure a positive experience for all.)

Consent Authorization

Typing your name on this form is considered your signature.
HEALTH INFORMATION: The health information provided above is correct so far as I know. The person herein described has permission to engage in all activities except as noted. I hereby give permission to the Adult-In-Charge to provide routine health care. I consent for my child to receive such medical treatment and/or surgical procedures as are deemed necessary in the event of an emergency and to assume liability for any medical expenses involved. This authorization extends to my child’s participation in any activity sponsored by MITY. Should a medical emergency arise during my child’s participation in a MITY-sponsored activity, I understand that reasonable efforts will be made to contact me or my designated alternate at the phone numbers I have given. If it is believed my child’s life or health may be adversely affected by the delay that an attempt to contact me or my designated alternate would cause, I consent to the administration of medical treatment and/or surgical procedure deemed necessary by the medical doctor and/or medical facility and the immediate administration of life-sustaining measures deemed necessary under the circumstances.

PHOTO RELEASE: I authorize Minnesota Institute for Talented Youth to use any photos or video of my student for presentations, advertising, publicity and promotion. MITY will never use a student's name.

CANCELLATION POLICY: I have read and understand MITY's Cancellation Policy:
- Prior to 30 days of session start date = 100% refund
- 15-29 days prior to session start date = 50% refund
- 8-14 days prior to session start date = 25% refund
- Within 7 days prior to session start date = No refund
- If MITY cancels a course before it begins, students will be placed into their second-choice class. Refunds are not provided once a session begins. In the unlikely event that MITY terminates a course during the session, MITY will consider the circumstances and may, at its sole discretion, issue a partial refund or credit.
CODE OF CONDUCT: By signing below, I acknowledge that both the student named above and myself, as their parent or legal guardian, have read and agree to abide by the MITY Code of Conduct. I understand that violations of these rules or any other inappropriate conduct may result in discipline, including dismissal from the program. Students who are asked to leave the program for discipline issues will not receive a tuition refund.
Parent/Guardian Signature*

First NameLast Name
Today's Date*

MonthDayYear
Once you submit the application you cannot go back. If you have any questions or wish to make changes to your application, please contact the MITY office at 651-243-2221 or info@mity.org.

Submit Payment

Full payment, or a completed financial aid form, is required in order for an application to be reviewed. Families receive a full refund if a student is not admitted.
SELECT THE QUANTITY OF ALL RELEVANT ITEMS BEFORE CHECKING OUT. If you only check the box next to an item, it does not appear in the total amount due.
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Elementary Program Tuition
$170.00 Quantity



Sibling TuitionSelect this option for any additional siblings who are attending the same session.
$140.00 Quantity



Financial Aid TuitionUse if student qualifies for free or reduced education benefits and has been approved for financial aid by MITY staff.
$45.00 Quantity



Optional DonationMITY relies on donations and grants to provide financial assistance to students in need. 100% of your donation goes to scholarships.
$10.00 Quantity



Total

$0.00

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

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Elementary Program Application: Winter Session

Parent / Caregiver Information

Class Selection: Grades 1 and 2

Class Selection: Grades 3 and 4

Health Information

Consent Authorization

Submit Payment