Student's Legal First Name

Middle Name

Last Name

Student's Preferred Name (if different)

Address

City

State

Zip Code

Year Applying For Year Applying For2020-20212021-2022

Grade Applying For Grade Applying For9th10th11th12th

Current Grade Current Grade8th9th10th11th12th

Current Age

Gender/Expression

Student's Pronouns Student's PronounsHe/HimHe/TheyShe/HerShe/TheyThey/ThemZe/Zir

School Student Currently Attends

Student's Date of Birth

Parent / Guardian Name

Cell Phone

Parent Email Address

Other Parent / Guardian Name

Home Phone Number

Email of Other Parent/Guardian

Best Phone Number Best Phone NumberHome PhoneCell Phone

Name of Parent/Guardian who Student Resides With

Phone of Other Parent/Guardian

Sibling of Current Inspire Student Sibling of Current Inspire Student Yes No

Sibling Name

Is your student interested in one or more of the following areas? Is your student interested in one or more of the following areas? Vocal Music Video Fine Art Science Instrumental Music Theater Dance Engineering

Do parents/guardians live together? Do parents/guardians live together? Yes No Does Not Apply

Is your student currently receiving special services? Is your student currently receiving special services? Yes No

Has your student received special services in the past? Has your student received special services in the past? Yes No

If so, which services? If so, which services? Resource Specialist Auditory Processing Problems Chapter I / Title I Gifted / Talented Behavioral Intervention Problems 504 Designation Speech / Language Special Day Classes Visual Perception Problems Indian Education Adaptive P.E. Other

Does your student have an IEP? Does your student have an IEP? Yes No

Has your student had an IEP in the past? Has your student had an IEP in the past? Yes No

I guarantee that the information in the application is correct. (Please type your name and today's date)