TRIAD MATH AND SCIENCE ACADEMY
Online Student Application Form
   
 
  DEAR PARENTS AND APPLICANTS:
  Thank you for considering Triad Math and Science Academy (TMSA) for your child's education. The email address to be entered below will be used for correspondence between you and TMSA for all school announcements and registration details and updates. Please fill out this application form completely. Falsifications, misrepresentations or omissions may disqualify your application.
   
   Applicant's Personal Information
   
      Year Applying: *
  Grade Applying: *
  Last Name: *
  First Name: *
Middle Name:
  Suffix:
  Date of Birth: *
  Gender: *
 
   Applicant's School Information
   
  Current School: *
  School District: *
  School Address:
  School Phone:   XXX-XXXXXXX
  School Fax:   XXX-XXXXXXX
  Years Attended From:   *
 
   Applicant's Family Information
   
  Applicant lives with: * If Other  
         
  Primary Parent: * If Other: *
  Title:    
  First Name: * Last Name: *
  Street: *
  City: * State: *      Zip: *
  Home Phone: * Work Phone:
  Cell Phone: Email:
         
  Secondary Parent: If Other :
  Title:    
  First Name: Last Name:
  Street:
  City: State:      Zip: 
  Home Phone: Work Phone:
  Cell Phone: Email:
         
         
   How did you hear about Triad Math and Science Academy ?
   
   
       
           
  Please briefly state why you wish to have your child enrolled at Triad Math and Science Academy.  
   
 
I/We hereby certify that, to the best of my/our knowledge and belief, the answers to the foregoing questions and statements made by me/us in this application are complete and accurate. I/We understand that any false information or misrepresentations of facts may result in rejection of this application or future dismissal of the applicant.