2015-2016 Application STEM Early College Academy (Program located at Fairfield Middle School) Questions: Phone: 803.635.4607 ext. 10318 Fax: 803.635.4520 Email: [email protected] 1. APPLICANT INFORMATION Student’s Name: ______________________________________________________________________________________________ Last First Mailing Address: (if different than residence address) Street Address_________________________________ City __________________ Zip Code __________ Residence Address: Street Address_________________________________ City __________________ Zip Code __________ Gender: ___F ___ M School Currently Attending for 6th Grade: FES GES KME FMSMS MLST Birthdate: ______/_______/______ Month Day Middle OTHER ___________________ (List Name of School) Year 2. PARENT/GUARDIAN INFORMATION Parent/Guardian Name: ____________________________________________________________________________________ Last First Phone: HOME______________ WORK _______________ Middle CELL _____________ EMAIL ADDRESS: _____________________________ Parent/Guardian Name: _____________________________________________________________________________________ Last First Phone: HOME________________ WORK _______________ CELL _____________ EMAIL ADDRESS: _____________________________ 3. TWO LETTERS OF RECOMMENDATION School Administrator Current Teacher Middle (PLEASE ATTACH ORIGINAL SIGNED DOCUMENTS TO THIS APPLICATION) Former Teacher Other _____________________________ Please check the positions of the individuals who are recommending the student. One letter must be from a school administrator or teacher. PARENT SIGNATURE: Parent Signature ____________________________________ Date__________________________ 2015-2016 SCHOOL YEAR APPLICATION DEADLINE: February 25, 2015 at 4:00 PM This application must be filled out completely and accurately by a parent with custodial authority or by a legal guardian. New students entering the district must register and be approved by the District Registrar before completing a program application. Incomplete applications will not be processed. Please return to the attention of Fairfield County School District, Dr. Jennifer Etheridge, Director of Special Projects, 1226 Hwy 321 By-Pass South, P.O. Drawer 622, Winnsboro, SC 29180. A separate application must be submitted for each child in the family. Cumulative grade point average (GPA) and standardized test scores will be considered along with a student interview, writing sample, and math pre-assessment to determine acceptance.