Galaxy Middle S.T.E.M. Academy

“Specializing in Science, Technology, Engineering, and Math”

APPLICATION FOR 6TH GRADE ADMISSION

Mr. Tom Russell, Superintendent

Ms. Patricia Corr, Principal

Mr. Tony Goodin, Assistant Principal

Ms. Alicia Douglas, Assistant Principal

Ms. Sharon Blanton, Assistant Principal

2400 Eustace Avenue

Deltona, Florida 32725

Telephone (386) 575-4144

Email:

Last Name:______First Name:______

Current School:______Current Grade: ______

Student Application for Admission

Applicant’s Name______

LastFirstMiddle

Address______Zip______

House NumberStreetApt#

Date of Birth___/___/___ Email address______

Male___Female___Present Grade___Current School______

Guardian #1 Guardian #2

Name______Name______

Home Address______Home Address______

Home Telephone______Home Telephone______

Cell Phone______Cell Phone______

Business Telephone______Business Telephone______

Email______Email______

List any professions or fields of study you may be interested in.

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Have you participated or plan to participate in any activities in school, community, or place of worship? Please specify:

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Name three things that you would like to accomplish if accepted into the academy?

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If accepted into the program, would you be taking physical education through virtual school, physical education waiver form, your one non-academy elective or other? If other, please explain.

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A third of the work completed through the academy is group project based. How will you deal with conflicts between you and other individuals?

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While most of the work will be completed during school hours, would you have the capability to complete work after school that may require the use of the internet or other technology?

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The academy is limited in size, and class changes within the program are severely limited. How will you deal with conflict between you and your instructor?

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Community service, school spirit, and academic excellence are primary attributes of our program’s mission. With this in mind, how would you contribute toward these goals?

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For the safety and comfort of all of our stakeholders, built within our program is time to organize and clean the classrooms, labs, and facilities. How would you react if you were asked to clean an area that you did not actively use?

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Do you feel that general housekeeping duties teach real world responsibilities? Yes/No

Please explain your answer:

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Galaxy Middle S.T.E.M. Academy strives to provide EQUITY (to provide tools so each individual can succeed), through the use of Personalized Learning. Our classrooms are highly diverse and each student has different strengths and weaknesses. How would you feel or react if another individual was provided an easier/simpler project to accomplish?

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Many of the projects that are completed in the academy have a direct link to the community. How do you feel about making phone calls and/or contact to professionals in the community (example: calling a director of operations at a local power plant while researching renewable energy)?

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Galaxy Middle S.T.E.M. Academy is a hands-on/minds-on school. In a regular school environment, the teacher does the vast majority of the work. In this system, the student is required to be the primary active participant. How are you prepared to take on this responsibility?

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Guardian acknowledgement

I acknowledge that the above responses are in-line with our values, and we will be supportive of Galaxy Middle S.T.E.M. Academy.

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Guardian #1 Guardian #2

Parent Acknowledgement of Admission

Our admissions policy seeks students who have achieved proficiency in reading,
writing and mathematics skills, and whose performance testifies to their commitment to
learn in all their studies.Galaxy Middle S.T.E.M. Academy seeks students who
are not only able but who have expressed and/or demonstrated an interest in science,
technology, engineering, art or math and want to become involved in a rigorous academic
environment which emphasizes these subjects.

Details about Enrolling

(A) There will be no discrimination in the admission of students to the school on the basis of race, creed,color, disability, or sex.

(B) The school will assert its best effort to attract a diverse student body that reflects the community, andthe school will recruit students from disadvantaged and underrepresented groups.

Admissions

Prospective students must submit written/typed applications. Every student willgo through a personal interview during which there will be a review of the applicant’s most recentacademic and attendance records to insure that Galaxy Middle S.T.E.M. Academy is an appropriate potential option and educational placement. Additional writing samples may be required during the application process. Throughout this process, a committee comprised of the student, family, and faculty will create an academic focus plan to guide the student Galaxy Middle S.T.E.M. Academy.

Due to the nature and rigor of the academic content to be delivered, students should have a passion forlearning. It is highly recommended that students have solid attendance records with very few absences.Due to this early college model and mastery-based learning system, students will need to demonstratepersistence when faced with challenging academic expectations.

I hereby certify that I have read and understand the enrollment and admission guidelines above,and that this application has been filled out to the best of my knowledge.

Guardian Participation

Galaxy Middle S.T.E.M. is a program that stresses self-reliance, self-advocacy, and community. Students who are accepted into the academy are expected to do more duties and functions then they have in other academic environments. Cleaning, landscaping, organizing, fundraising, and community service are fundamental aspects of the program. Every individual will have a unique experience while participating in the academy. To meet the Hands-On needs of our students, we may require a yearly fee up to $100 per child participating in the program. This fee is used towards materials used, and in-county fieldtrips to local companies and manufacturers. Additional field trips that require an entrance fee is separate.

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Signature of student Date

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Printed name of student

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Signature of guardian #1 Date

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Signature of guardian #2 Date