Student's Name: ____________________________________

Name of Current School: _______________________________

Mailing Address: ___________________________________

_______________________________________________

Telephone Number: _________________________________

Email address: ________________________________ (please write very clearly as you will be notified of acceptance by email and if I cannot read this, I cannot contact you)

Are you going into 9th or 10th grade next fall: ________________________________

Social Security Number: ______________________________ (the Regent's use this to track students in the State of OK)

Grade Point Average: ________________________________

Gender:

Ethnicity: _____ African American             _____ American Indian or Alaskan             _____ Asian American             _____ Hispanic

_____ Caucasian         ____ Multiracial

Gender and Ethnicity are not used to make admission decisions, it is for informational purposes only.

Name of Parental Guardian (print): _______________________________

Signature of Parental Guardian: _________________________________

In addition, please write a 1 page (preferably typed) statement on why you want to come to this academy.

In addition, please provide a Letter of Recommendation from a teacher again preferably typed.

All notifications will be by email, thus you must have a legible email address!