CHRISTOPHER SCHOOL 7TH AND 8TH GRADE
STEMS LEADERSHIP ACADEMY
DIRECTIONS FOR COMPLETING THIS APPLICATION
Please complete a separate application for each child. Please print clearly and sign the back of this application. Applications are
due to our school office no later than February 24th at 3:30p.m. Signing this application means that you are making a two
year commitment to this program.
STUDENT APPLICANT INFORMATION
First Name:
Current Grade:
Gender (please circle): Male Female
Last Name:
Current School:
Ethnicity : Caucasian African-American
Other ______________
Asian
Hispanic
Birth Date:
PARENT / GUARDIAN INFORMATION
First Name:
Relation to Student:
Home Address
First Name:
Relation to Student:
Home Address
STUDENT ACADEMIC HISTORY
Does the student have an IEP? Yes
No
Last Name:
Phone:
Email:
Last Name:
Phone:
Email:
Is the Student an English Language Learner?
Yes
No
PARENT INTEREST
What are your hopes for your son/daughter regarding the 7th/8th Grade STEMS Leadership Academy?
VOLUNTEER OPPORTUNITIES
( ) Tutor Students
( ) Assist in Classroom
( ) Guest Speaker
Topic:________________________
( ) Chaperone Field Trip
( ) Engineering Experience
( ) Science Experience
( ) Art Experience
( ) Math Experience
( ) Other: ________________________
STUDENTS MUST ANSWER THE QUESTION ON THE BACK OF THIS APPLICATION
OFFICE USE
CST SCORE
LA_____/M_____
A/D
DATE:_________
R
______________________
WL#
______________________
OTHER
STUDENT ESSAY
Please share your reason for joining the 7th and 8th grade STEMS Leadership Academy versus attending your regular
Intermediate School.
By signing this document, I hereby request admittance into the 7 th and 8th grade STEMS Leadership Academy at
Christopher School. I also acknowledge that this is a two year commitment and that students will forgo their admittance
into their regularly assigned Intermediate School. Students will be informed of their application status by the end of
March.
Parent Signature (s): _________________________________
Date ____________
__________________________________
Date ____________
Student Signature: __________________________________
Date____________