Academy of Environmental Science
Student Online Application
Student ID Number *
Student Name (Last, First, Middle) *
Address (Street, City, and Zip) *
Phone Number (Home) *
Phone Number (Cell) *
Date of Birth *
Gender *
Current School *
Current School Counselor *
Current Grade *
How many discipline referrals have you received in the past school year? *
How many days of school have you missed without a medical reason? *
Applying for Grade *
Special Needs (if any)
Is English your 2nd Language? *
Parent/Guardian Name *
Parent/Guardian Name
Parent/Guardian Employer *
Parent/Guardian Employer
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