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SouthTech Academy
SOUTHTECHACADEMY Type or print this form in blue or black ink. Complete one application per child. Complete all information requested. Completion of this application does not guarantee admission. Falsification of information on this application could lead to ineligibility for SouthTech Academy programs.
DO NOT WRITE IN THIS SECTION FOR ADMINISTRATION ONLY Date Received
ESE
_________GPA
504
ON TRACK ______YES
ESOL
————-FCAT Writing
_____/___ Attendance/Year
_____/____Referral/Year
______NO
_________FCAT/FSA Reading
__________FCAT Math
_________Level
__________Level
_____/____Attendance/Year
_____/____Referral/Year
_____/____Year/Grade
______/____Year/Grade
_____/____ Conduct/Year
_____/____Conduct/Year
___________Alg 1 EOC
_______/____Year/Grade
NAME OF STUDENT (last, first, middle initial)
For more information, call . Return completed application to: SouthTech Academy 1300 SW 30th Avenue Boynton Beach, FL 33426 FAX: 561.374.7213
STUDENT NUMBER
GRADE APPLYING FOR
BIRTHDATE (month/day/year)
DENT NUMBER NAME OF PARENTS(S)/LEGAL GUARDIAN
CURRENT SCHOOL
GENDER
DENT NUMBER
□ Male
HOME ADDRESS (street/apt. number)
STATE
ZIP
HOME TELEPHONE
[
]
]
CITY
EMAIL ADDRESS
BUSINESS TELEPHONE
[
□ Female
]
UMBER
HOW DID YOU HEAR ABOUT SOUTH TECH ACADEMY ___Friend/Relative (Name) _______________________ ___Advertisement ___Guidance Counselor ___Recruiter ___Other _________________________
CELLULAR TELEPHONE
[
D
NAME OF SIBLING (S)* (currently attending SouthTech Academy)
]
MBER
PROGRAM
BIRTHDATE
CURRENT GRADE
D
MBER
D
MBER
D
MBER
D
MBER
D
MBER
D
MBER
*Siblings are defined as children living in the same home.
FOR THE PARENTS OF ESE/504 STUDENTS ONLY Please provide a copy of your child’s current IEP or 504 Plan in order to assist in the planning process. DIRECTIONS FOR CHOOSING ACADEMY PROGRAMS Indicate your first, second, and third program choices by placing “1” for first choice, “2” for second choice, and “3” for third choice in the columns marked “#.” Only three program choices are permitted. #
ACADEMY
#
ACADEMY
AUTO COLLISION REPAIR/REFINISHING
INFORMATION TECHNOLOGY
AUTOMOTIVE SERVICE TECHNOLOGY
MARINE ENGINES SERVICE TECHNOLOGY
BUSINESS MANAGEMENT
MEDICAL SCIENCES CAREERS
COMMERCIAL ART TECHNOLOGY
MOTORCYCLE SERVICE TECHNOLOGY
COSMETOLOGY
MUSIC & SOUND PRODUCTION (Formerly Entertainment Management)
CULINARY ARTS
VETERINARY ASSISTING
DIGITAL FILM & BROADCAST (Formerly Recording Arts) PARENT/GUARDIAN SIGNATURE
By signing below, I hereby verify that all the above information on this application is true and correct.
SIGNATURE OF PARENT/GUARDIAN SouthTech Academy enrolls students without regard to sex, race, disability, creed, or ethnic origin. SouthTech Academy has a zero-tolerance policy for possession of guns, drugs, or for gang-related activities on school property. Offenders will be withdrawn. STCAI 1571a (Rev. 02/21/17)
DATE
SouthTech Academy 1300 SW 30th Avenue Boynton Beach, Florida 33426
www.southtechschools.org
"SouthTech Academy's core mission is to graduate students prepared for work, higher education, and productive citizenship." SouthTech Charter Academy, Inc. prohibits discrimination against students, employees, and applicants on the basis of religion, race, ethnicity, national origin, color, sex, marital status, age, parental status, pregnancy or disability in all employment practices, programs, services or activities. For questions contact 561-369-7042.
