2019 Advanced STARTALK Application
For returning 2018 STARTALK Academy students only. Students will be selected by lottery for the Advanced STARTALK Academies. DEADLINE IS MAY 24, 2019.
6/24/19 - 7/18/19 at Providence Elementary School
(Thursday, July 4 is a Holiday)
Monday - Thursday 8:00 AM - 12:00 Noon
Student's First Name
Student's Preferred Name (if different than First Name)
Student's Middle Name
Student's Last Name
Which STARTALK Academy did student attend last summer?
2018 STARTALK Elementary Chinese Academy
2018 STARTALK Elementary Russian Academy
Please list any allergy that requires the attention of staff.
Please note here if student has been identified as eligible for Special Education services or has an IEP or 504 Plan. Documentation must be provided upon acceptance into the program.
What is student's birthdate?
Will student be in 6th grade in September 2019?
Which school will student attend in September 2019?
Bayside 6th grade Campus
Brandon Middle School
Brickell Academy at Old Donation School
Corporate Landing Middle School
Great Neck Middle School
Independence Middle School
Kempsville Middle School
Landstown Middle School
Larkspur Middle School
Lynnhaven Middle School
Plaza Middle School
Princess Anne Middle School
Salem Middle School
Virginia Beach Middle School
What is student's gender?
Special Circumstances. Please share this information with the Program Director.
Will the student take the bus?
Yes (all or some days)
No (never; parent will provide transportation all days)
I do not know yet.
What is student's T-shirt size?
Name of Parent(s) or Guardian(s)
Home Phone Number
Mother's Cell Phone Number
Mother's Work Phone Number
Father's Cell Phone Number
Father's Work Phone Number
Street Address / Mailing Address
(Post Office Box addresses are not acceptable. Please include Zip Code.)
Confirmation of receipt of application will be sent by e-mail so please indicate one you use frequently.
If you have an Emergency Contact other than a Parent or Guardian
Provide Name, Phone number, and Relationship to Student
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