Summer Enrichment Academy Application

Information and Registration

For Current 3rd, 4th, and 5th Graders
By Invitation Only

 

Please read the entire application FIRST and make sure you have ALL the information you need in order to complete the form in one session. There is no way to save and return later without losing your work!


Student Information (All Fields Required)

Student's Last Name:  

Student's First Name:  

Student's Date of Birth:  

Student's Current Grade:  

Student's Current School:  

 

Parent/Guardian Information

Parent/Guardian Name:  

Address:  
City:          
State:        
Zip:           

Home or Cell Phone:  
Work Phone:

Email Address:  

 

Location Preference

1st Choice:  

2nd Choice:  

 

Session/Week Preference

1st Choice:  

2nd Choice:  

 

Program Preference

Breakout/Escape Room

Academic Extension Preference (Order from 1 through 6)

Reading / Language Arts
Math
STEM / Engineering & Building
Arts Integration
Technology
Logic

 

Scholarship

Are you requesting a scholarship for your student?  

If you answered yes above, please select the one that applies.


 


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