Riverside Science Academy Online Application

Thank you for considering Riverside Science Academy for your child's education. Your application will be entered into our application pool. Final registration will be completed later on campus. The email address to be entered below will be used for correspondence between you and RSA for all school announcements and registration details and updates.

First Name *

Middle Name

Last Name *

Date of Birth *

Your Name *

Your Relationship to Applicant *

Home Address *

Mailing Address
(if different than Home Address)

Home Phone XXX-XXX-XXXX*

Work Phone XXX-XXX-XXXX

Cell Phone XXX-XXX-XXXX

Email

Preffered Mode of Contact *

Current School *

Applying for Grade
6th 7th

ESOL
Yes No
If Yes,Home Language:

Special Education
Yes No
If Yes, Area:

GIFTED
Yes No
If Yes, Subject(s):

Is the applicant curently under expulsion?
Yes No
If Yes, please explain:

Has applicant ever skipped grade?
Yes No
If Yes, What Grade:

Gender
Female Male

Race
Asian African-American Caucasian Hispanic Multi-racial

How did you hear about us?
Media Brochure Friends Web Site
Other:

I hereby certify that, to the best of my knowledge and belief, the answers to the foregoing questions and statements made by me in this application are complete and accurate. I understand that any false information, omissions, or misrepresentations of facts may result in rejection of this application or future dismissal of the applicant. I also understand that Riverside Science Academy will contact me for future communication.

I accept terms and conditions explained above