Applicant Information Student Name School Date of Birth Date of Birth: Year Year1965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025 Date of Birth: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Date of Birth: Day Day12345678910111213141516171819202122232425262728293031 Gender - Select -MaleFemale Grade Age T-shirt Size Ethnicity - Select -Hispanic or LatinoNot Hispanic or Latino Race Race - Select -Black or African AmericanAsian AmericanCaucasianAmerican Indian or Alaska NativeNative Hawaiian or other Pacific IslanderOther… Enter other… Does your child walk home? - Select -YesNo Parent Information Parent/Guardian Name Mailing Address Mailing Address City State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Phone Email Address Email Address Confirm email Emergency Contact & Medical Information Name Relation to Applicant Phone List 2 people (if applicable) who are authorized to pick up your child from the Brady S.T.E.M. Academy: Name Relation Phone Name Relation Phone Allergies List (if applicable) any & all allergies (food or other) that your child may have: Forms To complete your student’s application, please submit the student assent form, parent consent form and media release form. Captcha CAPTCHA Get new captcha! What code is in the image? Enter the characters shown in the image. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.