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Stratford Academy Johnson House Application For Grade 6
**FOR STUDENTS ENROLLED IN GRADE 6 SEPTEMBER 2017 ONLY**
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* Indicates required question
Student's Last Name:
*
Your answer
Student's First Name:
*
Your answer
Student's Middle Name:
Your answer
Birth Month:
*
Choose
January
February
March
April
May
June
July
August
September
October
November
December
Birth Day
*
Choose
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Gender:
*
M
F
First Initial First Name
*
Choose
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
First Initial Last Name
*
Choose
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
Ethnic Group: (choose all that apply)
*
(01) American Indian/Alaskan Native
(02) Asian
(03) Black/African American
(04) Caucasian
(05) Hispanic
Required
Parent/Guardian Name:
*
Your answer
Home Address:
*
Your answer
Home Phone:
*
Your answer
Work Phone:
Your answer
Email:
*
Your answer
Please check any services your child is currently receiving:
Speech
Social Work
Resource room
Reading
Other:
Applicant's Base School
*
You can find your base school by looking at the STREET DIRECTORY which is located under the Parent's tab on the district website.
Choose
Chapel
Eli Whitney
Franklin
Lordship
Nichols
Second Hill
Stratford Academy
Wilcoxson
Other
Current Grade:
*
Choose
Pre K
K
1st
2nd
3rd
4th
5th
6th
School Currently Attending:
*
Choose
Chapel
Franklin
Victoria Soto School
Second Hill
Johnson House
Lordship
Nichols
Eli Whitney
Wilcoxson
Other
If Other - Where Does Student Attend?
*
Your answer
Do you have children attending Stratford Academy at this time:
*
Yes
No
If, yes, please list name(s) and current grade:
Your answer
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