Monroe Public Schools STEM Academy Application for 2016-2017 School Year Application Deadline: December 4, 2015 by 3:00 PM Return to:







Student Information









Mrs. Judy Dwyer The STEM Academy 1014 Monroe Turnpike Monroe, CT 06468 ATT: 2016/2017 Application

Current School: _________________________________________________________________ Current Grade: ___________ Student Last Name: ______________________________ First Name: ____________________________________ Address: ___________________________________________________________________________________________________________________ Primary Telephone: __________________________________________________________________________ Parent /Guardian Email Address: _______________________________________________________________________________________ PLEASE BE SURE TO PRINT CLEARLY AND CHECK YOUR EMAIL ON A REGULAR BASIS , THIS IS WHERE YOUR LOTTERY NUMBER WILL BE SENT. Please note: This year, any prospective student who has a sibling currently in Grade 6 or Grade 7 at the Academy automatically secures a position for the 2016-2017 school year if desired. In future years, a decision concerning automatic acceptance of siblings will be based on available enrollment and space information. Do you have a sibling who is currently in Grade 6 or Grade 7? Please list sibling names below. Sibling 1 ______________________________________________ Sibling 2 _________________________________________________



Upon receipt of your application, parents will receive an emailed confirmation along with a confidential number. After the lottery process is complete, a list of numbers will be posted on the district’s main website. The STEM Academy is accepting seventy-five students .

As the parent/guardian, I certify that my child has my permission to participate in the Monroe Public Schools STEM Academy should he/she be selected through the lottery process. I understand that there are seventy-five spaces available for the Academy and that my submission of this Application for the 20162017 School Year expresses a one year commitment to attend. If selected my child will attend. Parent Name: ____________________________________ Date:________________________________ (please print) ALL APPLICATIONS MUST BE MAILED OR DROPPED OFF AT THE STEM ACADEMY NO E-MAILS PLEASE Signature: ___________________________________________________