Broward Math and Science Schools Application Form

Student Information

Name^*

Gender

MaleFemale

Race^*

Ethnicity^*

School Year Applied For^*

Grade Applied For^*

Did the student attend a VPK?

YesNo

Date of birth^*

Parent/Guardian Information

Name^*

Relationship to Applicant^*

Resident Address^*

Mailing address

if different than resident address

Primary Email^*

A valid email address is required to complete this application. You will receive instructions in the email provided to confirm your application. If not confirmed within 7 days, submitted applications will be discarded.

Alternate Email

Home phone^*

Work phone

Mobile phone

Other information

Do you currently have a student attending our school?

YesNo

Are any of your other family members applying for placement at our school this year?

YesNo

You must submit a separate application for each sibling.

Is the applicant receiving ESOL services?

YesNo

Is the applicant receiving Sp. Ed. services (ESE)?

YesNo

Has the student been officially identified as Gifted?

YesNo

Is the applicant currently under expulsion or has ever expelled before?

YesNo

Has applicant ever skipped grade?

YesNo

Has applicant ever retained grade?

YesNo

text

Current School

How did you hear about us?

Terms and Conditions:

I hereby certify that, to the best of my knowledge and belief, the answers to the foregoing questions and statements made by me in this application are complete and accurate. I understand that any false information, omissions, or misrepresentations of facts may result in rejection of this application or future dismissal of the applicant. I also understand that the School will contact me for future communication.

I agree to the above terms