Orbis Project-Based Experience Enrollment Form (ACSD)
The enrollment process for Orbis Project-Based Experience includes 1) submission of this form, and, 2) signing up for Orbis during course registration with your school counselor.
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Student Information
The following demographic information included serves two purposes: 1) enrolling you in Ankeny School District's Student Information System (Infinite Campus), and, 2) providing our Orbis team with data to track over time pertaining to equity and program evaluation.
Student Last Name *
Student First Name *
What do you like to be called? *
Student ID Number *
Mailing Address *
City, State, ZIP Code *
Phone Number *
Student Email *
Date of Birth *
MM
/
DD
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YYYY
Are you of Hispanic, Latino or Spanish ethnicity? Includes persons of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin. *
Please check one or more of the following race categories. *
Required
School *
Graduation Year *
How did you hear about Orbis?(check all that apply) *
Required
How will you travel to and from Orbis? *
Help us get to know you
Our Orbis Guarantee: Whether or not you know your chosen career field, the skills you strengthen in Orbis are applicable to all career areas. Many students enter Orbis undecided on their career paths. Others enter Orbis with a strong passion in a particular career path, and Orbis either accentuates their career decisions or opens them up to new possibilities while drawing upon their interests and passions.
Why are you interested in enrolling in Orbis? *
What are your interest areas and passions? *
Do you have an interest in learning about skilled trades (plumbing, electrical, construction, etc.)? *
If you have specific career interests, what are they? *
What skills are you hoping to develop by enrolling in Orbis? *
Parent/Guardian Information
Name of Parent/Guardian *
Email of Parent/Guardian *
Phone Number of Parent/Guardian *
Thank you!
Thank you for enrolling in Orbis Project-Based Experience! Information regarding Orbis Orientation will be sent to you and your family. If you have any questions, please contact Dr. Jill Urich, Co-Director of Orbis and Principal of Centennial High School, at jill.urich@ankenyschools.org, or Mr. Peter Apple, Co-Director of Orbis and Principal of Ankeny High School, at peter.apple@ankenyschools.org.

Equity Notice: Ankeny Community School District does not discriminate based on race, color, creed, religion, national origin, sex, gender identity, age, disability, marital status, sexual orientation, physical attributes, physical or mental ability or disability, ancestry, political party preference, military affiliation, socioeconomic status, or familial status. Inquiries or grievances may be directed to Kenneth Morris, Jr., Equity Director, 306 SW School Street, P.O. Box 189, Ankeny, IA, 50021-0189, (515) 965-9600, kenneth.morris@ankenyschools.org; or the Iowa Civil Rights Commission, Grimes State Office Building, Des Moines, IA, 50319-0201, (515) 281-4121; or the U.S. Department of Education, Office for Civil Rights, 500 West Madison Street, Suite 1475, Chicago, IL 60661.
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