Eastvale STEM Academy 2019-2020 Wait List Application
Please complete this application in its entirety. Include a valid parent's email below.
Email address *
Today's date *
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Student's first name *
Your answer
Student's last name *
Your answer
Student's date of birth *
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CNUSD student number (if you are outside of district, please type 0) *
Your answer
Student's home address (ex: 7447 Scholar Way, Eastvale, CA 92880) *
Your answer
Parent's/Guardian's first and last name *
Your answer
Parent's/Guardian's primary phone number (ex: (951)738-2100) *
Your answer
Re-enter valid parent/guardian email address from above: *
Your answer
Which intermediate school is your student currently enrolled in as an 8th grader? *
If you marked "other" in the previous question, please state which district AND intermediate school your student is currently at (ex: CNUSD, Corona Fundamental):
Your answer
Does the student currently have an Individualized Education Plan (IEP)? *
Does the student currently have a 504 Plan? *
Which pathway does your student intend to be on? *
By typing in the student's full name below, your student certifies that he/she has read and agrees to the expectations of the Eastvale STEM Academy program as listed under Enrollment Information. The student also acknowledges that this is a wait list application and there are no guarantees of admission. Lastly, the student certifies that all of the information provided on this form is true and correct.
Student's electronic signature: *
Your answer
A copy of your responses will be emailed to the address you provided.
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