Orbis Project-Based Experience Enrollment Form (ACSD)

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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.

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 *

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. *

Yes

Please check one or more of the following race categories. *

American Indian or Alaska Native - Origins in any of the original peoples of North, Central, and South America who maintain a tribal affiliation or community attachment.

Asian

Black or African American

Native Hawaiian or Other Pacific Islander - Origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

White

Other:

Required

School *

Ankeny High School

Ankeny Centennial High School

Graduation Year *

How did you hear about Orbis?(check all that apply) *

Friend

Social Media

School Counselor

Parent/Guardian

Other:

Required

How will you travel to and from Orbis? *

I'm providing my own transportation

I'll use the Orbis shuttle

Help us get to know you

Our Orbis Guarantee: "Limitless learning beyond your comfort zone." You will:

Co-design your learning.
Be empowered as a young professional.
Collaborate with peers and the workforce while engaging in authentic work.

Why are you in Orbis? *

What are your interest areas and passions? *

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! If you have any questions, please contact Amy Steenhoek, Postsecondary Success Specialist and Director of Orbis, at amy.steenhoek@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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