Application Form

Summer Gifted Studies Program - June 22-27, 2008
Please note: If your child has not previously attended either the Saturday Gifted Studies Program, Summer Gifted Studies Program, or Summer Program for Academically Talented Youth, you must go back to the Web site and complete the application for first time applicants.
Date last enrolled:
To be completed by parents/guardians:

Choose the Courses in the Order of preference: (1 = first choice, 2 = second choice, 3 = third choice, etc.)

1.
2.
3.
4.
5.
6.
7.

Name of Student: Gender: Male Female Date of Birth:
Address:
Street: City:
State: Zip Code: Phone: - -
Parents e-mail address:
Fathers Name:
Occupation:
Bus. Phone: - -
Mothers Name:
Occupation:
Bus. Phone: - -
Social Security #:
Student: or Mother: or Father:
School: District:
Address:
Phone: - -  
Current Grade: Teacher: Principal:
Is this student currently participating in a state-approved program for intellectually and/or academically gifted children: ? Yes No
If yes, briefly describe program activities:
Is the student currently participating in other programs for
Learning Disability
Behavior Disorder
Speech Therapy
Visually Impaired
Hearing Impaired
Physically Impaired
Does the student currently have any medical or physical conditions that should be known if enrolled in the program? Yes No
If yes, please explain:
Person Completing this Form Date:
Are you applying for Financial Aid: Yes No
Because of limited funds available, we request that you first seek financial aid within your community.