Brazos Success Academy Program Application

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This form should be completed by the student that is requesting enrollment in the Brazos Success Academy.

Student's Last Name *

Student's First Name *

Student's ID# *

Student's Date of Birth *

YYYY

Student's Age *

Student's Gender *

Student's Cell Phone # (include area code) *

Student's Email *

Are you currently enrolled in BISD? *

Name of Home Campus (If "Other" please enter name/district)? *

Brazosport High School

Brazoswood High School

Other:

Required

Current Grade Level (Based on credits earned) *

9th Grade (0 - 5.5 credits)

10th Grade (6 - 11.5 credits)

11th Grade (12 - 18.5 credits)

12th Grade (19+ credits)

Home Address *

Mailing Address (if different from home address)

Student Lives With *

Parent

Guardian

Other. Explain below

If other, please explain.

Parent/Guardian Name & Relation to Student (Ex: Father, Mother, Aunt, Grandmother, Etc.)

Parent/Guardian Cell Phone #

Parent/Guardian Email Address

Emergency Contact Name

Emergency Contact Cell Phone #

What do you know about Brazos Success Academy? *

How are your grades? *

Please list your current your grade/cohort principal and counselor. *

Which campus professional have you consulted with about applying for BSA? (If you haven't please consult with your counselor or principal) *

Counselor

Assistant Principal

Required

How is your attendance? *

A I attend school daily

B I am absent 1-3 days a month

C I am absent 4+ days a month

D other

If applicable, what causes you to miss school? *

How well do you comply with the Student Code of Conduct? (consider a grading period) *

0 Office referrals

1-2 office referrals

3+ referrals

Have you ever been assigned DAEP or JJAEP? *

DAEP only

JJAEP only

Both

Neither

If yes, please provide an explanation below. *

Why do you want to attend Brazos Success and how do you think it will help you? *

What do you feel are your biggest challenges/issues at your current school? *

What would your current teachers say are your strengths? *

What would they say are your weaknesses

Do you presently have a job? If so where? Supervisor's name? hours per wk? work number? *

Do you have a child or are you expecting? *

Are you or have you been on probation? If so what are the terms? What is the name of your Probation Officer? *

What are your plans after graduating from high school? *

Workforce

Trade School

2 year college

4 year college

Military

Student's and Parents/Guardians understand that the goal of the Brazos Success Academy is to earn credits toward graduation from high school. Brazos Success is an online accelerated program. Students wishing to participate in NCAA (college athletics) would be better served at their home campus. In order to accomplish this goal, the following commitments are necessary. Please place a check by each item to indicate that you have read and understand the expectations set forth. *

I understand that completing this application does not guarantee acceptance. I will need to continue to attend school at my home campus and work to gain credits there. I also understand that priority for acceptance will be given to students with regular attendance who are working to be successful at their home campus.

I am learning to be "IN IT" to "WIN IT". (I will attend and be on time to school and classes. Students will not be able to leave campus during the instructional day without permission from the campus administration.)

I am "Becoming EMPLOYABLE". (I will comply with the BISD Student Code of Conduct. Employers have expectations also.)

I am learning to "Live in COMMUNITY". (I will be courteous and respectful of themselves, other and BSA staff.)

I am learning to be "FOCUSED and SUCCESSFUL". (I will store cell phones in the storage slot assigned to me during instructional hours. Cell phone privileges can be earned at lunch and break times. Student will participate fully in all activities and ask for assistance when needed.)

I have read and understand the above contract statements and agree to follow them. I understand that by signing this contract, I am making a commitment to attend regularly, work hard, and earn credits toward a diploma. I also understand that my academic, attendance, and disciplinary performance will be reviewed each six weeks and failure to comply with the above contract, may result in my acceptance and participation in the Brazos Success Academy being denied/revoked.

Required

Student's Electronic Signature: *

Parent Electronic Signature *

Parents - Why would you like your child to attend Brazos Success Academy? *

Date Application Completed: *

YYYY

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