Student Application and Questionnaire
Please fill out one enrollment application per student applying.
Your child's application will be processed when we receive your $150* application fee.

Admission to programs is open to all students regardless of race, sex, religion, ethnic origin or disability.

Application Fee: $150*
Checks can be made payable to: Portsmouth STEM Academy

Please include your child's name in the memo and mail your application fee to:
609 Second Street, Box E
Portsmouth, OH 45662

*A $50 application fee will be assessed to any family providing proof of qualification for an EdChoice scholarship. Please e-mail a copy of your EdChoice acceptance letter to information@portsmouthacademy.org

Payment Method
Application Date
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Student Information
Student's First Name
Your answer
Student's Middle Name
Your answer
Student's Last Name
Your answer
Student's Birth Date
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Gender Identification
Social Security Number
Your answer
Desired Enrollment Semester
Please choose the first semester your child will be attending Portsmouth STEM Academy. Terms begin in the following months: Fall: August | Spring: January | Summer: May
Grade Entering
Other Schools Attended (List All)
Please list: 1. Name of School 2. Addreess 3. Dates Attended
Your answer
School District in which Child Resides
Your answer
Home Address
Street, City, State, Zip
Your answer
State/Federal Ethnicity & Race Data Collection
The United States Department of Education requires educational institutions to collect racial and ethnic data for reporting purposes. This information is used solely for the purpose of determining compliance with Civil Right laws and will be kept confidential. We are requesting for each participant to ‘Self Identify’ and provide this information, however it is optional to Self Identify. If you choose not to Self Identify, then please be aware that Portsmouth STEM Academy will need to make a judgment of your child’s race and ethnicity because Civil Rights law requires them to do so. This ethnic and racial information will remain confidential and on file for 3 years and will only be accessible to authorized personnel. To Self Identify, please answer the following questions.
Ethnic Category (Choose One)
Persons of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture regardless of race.
Racial Categories (Check all that apply)
Please choose one or more racial categories. Those who choose more than one race will be identified as “multi-racial” for reporting purposes. If you do not self-identify, federal law requires that the district designate another staff person to choose one or more categories for you based on prior knowledge and observation; this practice is known as Observer-Identification. We firmly believe self-identification is preferable, but are required to implement Observer-Identification as a last resort to complete a record.
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