Applicant Information Student Name School Date of Birth Date of Birth: Year Year1964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Date of Birth: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Date of Birth: Day Day12345678910111213141516171819202122232425262728293031 Gender - Select -MaleFemale Grade Age 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 Menter Information Mentor Name (if applicable) 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 Name Relation Allergies List (if applicable) any & all allergies (food or other) that your child may have: Essay Question Why would you like to be a part of the St. Elmo Brady S.T.E.M. Academy? Students must complete this section. Respond in English or Spanish. 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.