Theta Alpha STEM Academy Registration
Register your student for the Theta Alpha STEM Academy by completing the form below. Please provide accurate and complete information.
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Email Address
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Student Full Name
*
First Name
Last Name
Student Grade Level
*
Please Select
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
Student School Name
*
Is your student a returning participant or attending for the first time?
*
First-time participant
Returning participant
How did you hear about the Theta Alpha STEM Academy?
*
School referral
Teacher or counselor
Friend or family member
Social media
Community event
Church or community organization
Previous Theta Alpha program
Other
If referred by a person or organization, please list their name (if applicable)
Signature
Submit Registration
Submit Registration
Should be Empty: