(If you are private or homeschooled, please enter "1111".)
Your answer
Student Home Address *
Your answer
Student City *
Your answer
Student Zip Code *
Your answer
Phone Number *
Your answer
Student Ethnicity *
Language Spoken at Home *
Current Middle School *
I live in: *
If I do not attend Delta, my boundary high school is: *
My 8th grade math class is: *
I am currently on an IEP: *
An IEP is a special education plan.
I am currently on a 504: *
A 504 is a health accommodation plan.
Parent/Guardian Name #1 *
Please include first and last names.
Your answer
Parent/Guardian Name #1 Address
Please include if this is a different address than the one listed by the student, above.
Your answer
Parent/Guardian #1 Home/Cell Phone *
Your answer
Parent/Guardian #1 Work Phone
Your answer
Parent/Guardian #1 Employer
Your answer
Parent/Guardian #1 E-mail
Your answer
Parent/Guardian #2, if applicable
Please include first and last names.
Your answer
Parent/Guardian #2 Home/Cell Phone
Your answer
Parent/Guardian #2 Work Phone
Your answer
Parent/Guardian Name #2 Address
Please include if this is a different address than the one listed by the student, above.
Your answer
Parent/Guardian #2 Employer
Your answer
Parent/Guardian #2 E-mail
Your answer
Reference #1 *
Please list an adult you feel knows you well. We may ask about your work habits, your potential, and your ability to be flexible in a small school environment.
Your answer
Reference #1 *
What is your relationship to the reference?
Reference #1 *
Phone Number
Your answer
Reference #2 *
Please list an adult you feel knows you well. We may ask about your work habits, your potential, and your ability to be flexible in a small school environment.