Please complete the fields below. Once you are finished, be sure to go back and review each section ...

Please complete the fields below. Once you are finished, be sure to go back and review each section before clicking the “Submit" button below. Once you click “Submit” you will no longer be able to make changes to yourapplication. You can save your application or return to a partially completed application by clicking the "Save" link in the lower right corner of the form. You have 14 days to return to a partially completed application. Once you submit your application, a confirmation receipt will be sent to the email address entered in the "Parent/Guardian 1" section below. If you have any questions, please contact Robert Estice (restice@wscloud.org).

Student Information

FIRST NAME :*

LAST NAME:*

Gender*

FemaleMale

AGE:*

BIRTH DATE:*

Date

STREET ADDRESS:*

CITY:*

ZIP CODE:*

Student EMAIL:

Student HOME PHONE:

Student CELL PHONE:

Current Enrollment Information

CURRENT DISTRICT:*

IS THE ABOVE STUDENT CURRENTLY OPEN ENROLLED?*

CURRENT SCHOOL:*

6th GRADE TEACHER:

HOME / FEEDER MS:*

THE ABOVE STUDENT BE A RESIDENT OF THE WORTHINGTON SCHOOL DISTRICT BEFORE THE 2016/17 SCHOOL YEAR.*

DOES THE ABOVE STUDENT HAVE A SIBLING THAT IS A CURRENT SEVENTH GRADER AT PHOENIX?*

NAME (FIRST AND LAST) OF SIBLING CURRENTLY ATTENDING PHOENIX (7th Grade):

Parent/Guardian Information

PARENT / GUARDIAN 1

1 FIRST NAME:*

1 LAST NAME:*

1 STREET ADDRESS:*

same as the student abovedifferent from the student above

1 STREET ADDRESS:

1 CITY:

1 STATE:

1 ZIP:

1 EMAIL:*

1 HOME PHONE

1 MOBILE PHONE

1 WORK PHONE

PARENT / GUARDIAN 2

2 FIRST NAME:

2 LAST NAME:

2 STREET ADDRESS:

same as the student abovedifferent from the student above

2 STREET ADDRESS:

2 CITY:

2 STATE:

2 ZIP:

2 EMAIL:

2 HOME PHONE

2 CELL PHONE

2 WORK PHONE

Student Questions

1) Tell us three things you would like us to know about you.*

2) What is your main reason for wanting to come to Phoenix Middle School? Please explain.*

3) What personal strengths do you find especially helpful in your learning?*

4) List any activities in which you are currently involved or have a desire to pursue (instruments, clubs, sports, etc.).*

5) Please give us the first and last names of any of your friends who may also be considering Phoenix Middle School.*

Student Online "Signature"*

By checking this box, I confirm that the above is my own work.

Parent/Guardian Questions

The Phoenix program emphasizes learning for mastery, connecting students’ understanding to the world in which they live, and supporting them in making positive contributions to their community. We believe we best serve students who are motivated to learn, willing to produce work, discuss and design some of their own learning experiences, and capable of accepting the responsibilities of being an active learner. What evidence can you offer that your child fits this description?

Please explain why you think Phoenix Middle School will be beneficial for your child. Please be as specific as possible in your explanation. [Please enter your response in the field below].*

Parent Online "Signature"*

By checking this box, I confirm that all information provided in this application is accurate.

OUR PRIVACY POLICY

Please be sure to go back and review each section before clicking the “Submit" button below. Once you click “Submit” you will no longer be able to make changes to your application. You can save your application or return to a partially completed application by clicking the "Save" link in the lower right corner of the form. You have 14 days to return to a partially completed application. Once you submit your application, a conformation receipt will be sent to the email address entered in the "Parent/Guardian 1" section above (check your spam folder if you don"t receive a receipt email). If you have any questions, please contact Robert Estice (restice@wscloud.org).