Mid-South Gifted Academy
Application for Admission
Personal Information
Student Name
First Name
Last Name
Gender
Male
Female
School Year
2019-2020
2020-2021
Grade Entering
Kindergarten
1
2
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9
Birth Date
Please select a month
January
February
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December
Month
Please select a day
1
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Day
Please select a year
2024
2023
2022
2021
2020
2019
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2015
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2012
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1920
Year
Parent Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Occupation/Place of Employment
Parent Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Occupation/Place of Employment
Education Background
List your child's schools, beginning with the most recent
School name
Grades Attended
School name
Grades Attended
School name
Grades Attended
Has your child been in any type of gifted program or advanced classes?
*
Yes
No
If yes, what programs or classes?
What do you see as your child's greatest strengths or skills?
*
What are your child's interests?
*
Does your child have any academic challenges?
*
Yes
No
If yes, explain.
Does your child have any behavioral challenges?
*
Yes
No
If yes, explain.
Does your child have diagnosed learning differences?
*
Yes
No
If yes, explain.
Has your child ever been suspended or dismissed from school for any reason?
*
Yes
No
If yes, explain, including the school and principal's name.
Has your child ever had a psychological evaluation?
*
Yes
No
If yes, please explain and email report to info@midsouthgiftedacademy.com.
Would you like to schedule an IQ test through MSGA?
Yes
No
Additional Information
Please tell us why you think Mid-South Gifted Academy will be a good fit for your child.
*
We want to know more about your child! Please tell us any information that you think would be helpful.
*
I am interested in participating in the Extended Open House option.
*
Yes
No
E-Signature
*
Fee
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Application Fee
$
100.00
Total
$
0.00
*Once you submit your application, you will be taken to PayPal to process your application fee.
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