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Step 1 of 6
16%
Part I. Applicant Information
Student's Name
*
First
Last
Date of Birth
*
MM
DD
YYYY
Gender
*
Male
Female
Home Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Zip Code
Home Phone
*
Student Cell Phone
Student Email
Please Check All That Apply:
*
Black
White
Latino/Hispanic
Asian
Native American
Bi-Racial
Other
If you checked 'Other', please specify
Do you speak any language other than English?
*
Yes
No
Has the student ever applied to an Independent School?
*
Yes
No
If Yes Please Specify
Do You Play A Musical Instrument
*
Yes
No
Does the student favorite subject? If yes, please specify
In which subject(s) does the student struggle most?
Applicant Education
Current School
*
Present Grade
*
School Address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Zip Code
Has the student ever skipped a grade?
*
Yes
No
If yes, which grade?
Has the student ever repeated a grade?
*
Yes
No
If yes, which grade?
Part II. Family Information
Applicant lives with (check all that apply)
Mother
Father
Guardian/Other
Student’s parents are (check all that apply)
Married
Separated
Divorced
Never Married
Mother Deceased
Father Deceased
What is the primary language spoken at home?
Does your child qualify for free or reduced lunch?
Yes
No
Parent/Guardian #1
First
Last
Address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Zip Code
Phone
Email
Are You a US Citizen?
Yes
No
If not, please specify
Current Employer
Employer Address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Zip Code
Occupation & Title
Highest Level of Education
8th Grade or Lower
12th Grade
GED
2 Yr. College
4 Yr. College
Graduate School
Parent/Guardian #2
First
Last
Address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Zip Code
Phone
Email
Are you a US Citizen?
Yes
No
If not, please specify
Current Employer
Address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Zip Code
Occupation & Title
Highest Level of Education
8th Grade or Below
12th Grade
2 Yr. College
4 Yr. College
Graduate School
Financial Information
What is the estimated total annual income for all parents, stepparents and guardians (including wages, disability, unemployment, social security payments, etc) ($)
What are the estimated family assets (including real estate, cars, businesses, bank accounts, etc)? ($)
Is your family willing to contribute financially to annual independent school tuition for your child? If so, how much? ($)
What is the number of dependent children residing with parent(s)/guardian(s)
Please list the names, ages, schools, and grades of the student's brothers and sisters
Emergency Contact Information
Name
First
Last
Address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Zip Code
Phone
Email
Please list medication your child is taking
Please list any medical conditions that may hinder the child’s participation in some activities
Part VI. Short Answer Questions for Applicant
Please answer the following questions to the best of your ability in the space provided. Please write neatly and clearly. You may submit additional information on a separate sheet of paper. Remember to proofread and check your work for spelling errors.
How did you find out about the Hartford Youth Scholars Foundation & Steppingstone Academy Hartford?
School Visit
Friend Relative
Teacher
Flyer
Community Organization
Other
The Steppingstone Academy Hartford is a big commitment. During the school year, Scholars are required to attend classes both after school and on Saturdays. Scholars also commit to attending our Steppingstone Academy for three consecutive summers. Having told you this, what motivates you to apply to the Steppingstone Academy?
*
First list three pieces of literature that you have read within the last two years outside of school – for example: a novel, a short story, a newspaper article or a poem. Then choose one that was meaningful or interesting to you, and explain why.
List all activities, hobbies, and groups you currently participate in at school, in your community, at church or at home. (Responses do not need to be written in paragraph form, you may list.)
List all honors you have earned, leadership positions you have held, and years you have participated in the activity. (Responses do not need to be written in paragraph form, you may list.)
What do you believe you can contribute to the HYSF community?
Part VII. Personal Essay
You must choose and respond to one of the topics below. Your essay should be no more than five paragraphs in length. Remember to proofread and check your work for spelling errors. Upload your document when you are finished.
Choose ONE topic
Choose a character from a book that you have read or a movie you have seen with whom you closely identify. Tell us about the character and why you identify with him or her.
Describe a time when you met a difficult challenge and overcame it. What did you learn from that experience?
Choose a person who has had a major influence on you. Describe the difference that person has made in your life.
Upload Your essay
VIII. Parent/Guardian Responses
What activities does your child enjoy?
Please describe your child’s strengths (academic and non-academic)?
What skills do you want your child to improve upon while taking part in The Steppingstone Academy Hartford?
Why do you want your child to attend The Steppingstone Academy Hartford and then an Independent School?
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