Student Name *

First Name

Last Name

Student Scholarship Information

Step Up Scholarship

John McKay

Gardiner

None

Other

Race

Hispanic or Latino

Not Hispanic or Latino

American Indian

White

Black

Asian

Other

Primary Guardian Name

Primary Parent/Guardian Name with legal authority over the student:

First Name

Last Name

Guardian 1 Phone

(###)

###

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Primary Guardian 2

First Name

Last Name

Guardian 2 Phone

(###)

###

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Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Address of Last School

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

School's Telephone

(###)

###

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By Checking this box: *

I attest that all information on this form and in the enclosed enrollment application is accurate. In addition, I also agree that I will be financially responsible for the above student’s fees, tuition, or any other financial obligation that is incurred.

I agree

Child's Name *

First Name

Last Name

Does the student have any disabilities that might limit his/her participation in class activities or that might affect his/her academic progress?

Yes

No

Does the student have an IEP or 504 Plan?

Yes

No

Does the student take medication?

Yes

No

Choose the scenario(s) that best describes your students learning style:

When learning new information your student learns best when stating the situation out loud then 
reasoning through the solutions out loud.

When in a classroom setting, your student learns best if sitting in front of the classroom taking notes.

Your student learns best when using visual analogies and photographs.

Your student learns best when involved in a study group. 


Your student learns best with flashcards and visual metaphors.

Your student learns best when using a computer to reinforce their sense of touch.

Child's Name *

First Name

Last Name

Parent/Guardian's Name *

First Name

Last Name

Name

First Name

Last Name

Phone

(###)

###

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Name

First Name

Last Name

Phone

(###)

###

####

Name

First Name

Last Name

Phone

(###)

###

####

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Work Phone

(###)

###

####

Address (If different from student)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Student's Name *

First Name

Last Name

Best Phone Number

(###)

###

####

Additional Phone Number

(###)

###

####

Name

First Name

Last Name

Phone

(###)

###

####

Name

First Name

Last Name

Phone

(###)

###

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