Name *

First Name

Last Name

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home or Cell # *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Name *

First Name

Last Name

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home or Cell # *

(###)

###

####

Electronic Signature *

The statements and information furnished by the undersigned in this application form are true and complete. The undersigned applicant’s parent(s)/guardian(s) give permission for representatives of the sending school to release the applicant’s records including, grades, attendance, conduct/discipline records, as well as any other pertinent information that may be required by Stellar Preparatory for the purpose of admission. Our signatures certify that we have read and agree with the above statements.

Signature of Student

Signature of Parent

Race:

Select all that apply

American Indian or Alaskan Native

Asian or Pacific Islander

Black

White

Hispanic