The Academy at Old Cockrill

Please complete all areas of the application that apply to you. Certain fields are required. When finished, click "Preview" to review your application before submission. From the "Preview" screen, you will be able to submit the application.

The online application process is:

Fill out and submit your application. Be sure to answer all of the questions as thoroughly as you can.
The principal and school counselor will review your application, transcripts and discipline reports, and you will then receive a phone call regarding your application.

Date of Application (today's date) *

Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone *

- Area Code Phone Number

Cell Phone

- Area Code Phone Number

Work Phone

- Area Code Phone Number

Place of Work

Date of Birth *

Age *

E-mail *

Parent / Guardian Name *

First Name Last Name

Parent / Guardian Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Parent / Guardian Phone Number *

- Area Code Phone Number

Last School Attended *

City and State of Last School Attended *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Are you currently enrolled in school?

Yes No

If you are not enrolled in school, please explain why.

Why are you applying to the Academy at Old Cockrill? *

What qualities do you want in a teacher? *

Do you have access to a computer and internet connection? *

Yes No

Where do you have access? Please check all that apply.

Home Library Neighbor / Friend

Do you know anyone currently enrolled at the Academy at Old Cockrill, or someone who graduated from the Academy? If yes, who? *

Has anyone in your immediate family attended college? *

Yes No

Please use the space below to write about yourself and tell why you think the Academy at Old Cockrill would be a good school for you. *

<label for="Plaintext2">Federal regulations require that all students enrollling in a public school answer the following questions. These questions provide us with valuable information on how to best serve you.</label>

Do you speak a language other than English? *

Yes No

Which language(s) do you speak?

What language did you first learn to speak? *

What language do you speak most often outside of school? *

What language do people usually speak in your home? *

Were you born in the United States? *

Yes No

In what country were you born?

What date did you enter the United States?

We have found that our most successful students are the students who have completed the application themselves. In good faith, we are presuming the student named above is the one who has completed the application. Filling out the application for someone else may result in the applicant not being accepted.

Please check one.

By checking this box you are certifying that the student named above as the applicant is the person who completed the entire application. By checking this box you are certifying that someone other than the student named above as the applicant is the person who completed the entire application.

The Academy at Old Cockrill - Application