Success Academy Student Application
Email address *
STUDENT INFORMATION
Last
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First
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School
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Date of Birth
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Age
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Gender
Phone Number
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Email Address
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Parent/Guardian Last Name
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Parent/Guardian First Name
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Parent/Guardian Phone Number
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Parent/Guardian Email
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Please check all that apply.
After graduation, I plan to attend:
Please answer all questions with complete sentences.
Do you feel you are are successful in your current learning environment? If not, what do you feel hinders your success?
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What are your strengths?
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What are your goals, dreams, and aspirations? How can The Success Academy help you reach them?
Your answer
A copy of your responses will be emailed to the address you provided.
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