Apply Now - The Academy For Scholastic and Personal Success

In addition to the application, High School applicants should mail a final transcript (Incoming 9th graders a final Grade report) to:

The Academy for Scholastic and Personal Success
PO Box 2842
Cedar Rapids, IA 52406

Applications and Transcripts are due May 1st
The Academy SPS Summer Session begins June 12th

If you have any questions, please contact Eric M. Thompson, Assistant Director at (319) 360-0409

Tuition: AM Session (M-F: 8a-12p) $200 / R.I.S.E Session (T&TH: 1p-3p) $100

(Students from the R.I.S.E. program who are invited to travel will be assessed an additional $100.)

AM or PM Session? *

AM Session (M-F: 8:00a-12:00p)

PM Session (T&TH: 1:00p-3:00p)

The R.I.S.E. program is a leadership program developed for those students who have conflicts from 8-12 Monday thru Friday. Do you have work or training conflicts?

Yes

Did you participate in The Academy Expansion Program?

Yes

Did you participate in The Academy AAAP Program?

Yes

Have you attended previous Academy SPS Summer Sessions? If so, how many?

First Name *

Last Name *

Student Cell Number *

Student Email *

Gender *

Pronouns

Age *

Birth Date

Nickname

Current School *

Current Grade *

Current Cumulative GPA *

*If the cumulative GPA is below 2.5, a letter of recommendation from a teacher or counselor must accompany the application.

Future School *

Future Grade *

Does the applicant have an IEP or 504? *

Yes

If yes, please provide a copy of the IEP/504

Does the applicant receive free or reduced lunch *

Yes

Is the applicant residing with someone other than a parent or legal guardian? *

Yes

Is the applicant currently in foster care? *

Yes

Is the applicant’s native language English? *

Yes

If not, please specify your native language

Has the applicant participated in any of the following accelerated academic learning programs? (Please check all that apply)

8th Grade Expanded Opportunities

AP Courses

PACT

Other

Has the applicant participated in Homeschooling? *

Yes

If yes, please list ages/grades

Please list all extracurricular activities you have participated in during this school year.

The child is in the custodial care of:

Both Parents

Mother Only

Father Only

Other

Parent/Household Information

#1 Parent(s)/Guardian(s)

Parent or Guardian Name(s) #1 (Primary Caregiver): *

Address *

City *

State *

Zip Code *

Home Phone Number

Cell Phone Number *

Email Address *

Are you currently employed? *

Yes

Please list your place of employment:

#2 Parent(s)/Guardian(s)

Parent or Guardian Name(s) #2 (if applicable):

Address

City

State

Zip Code

Home Phone Number

Cell Phone Number

Email Address

Are you currently employed?

Yes

Please list your place of employment:

Siblings:

Sibling 1 Full Name

Sibling 1 School

Sibling 1 Grade

Sibling 2 Full Name

Sibling 2 School

Sibling 2 Grade

Sibling 3 Full Name

Sibling 3 School

Sibling 3 Grade

Sibling 4 Full Name

Sibling 4 School

Sibling 4 Grade

Other Information:

Email a headshot or selfie image to theacademysps@gmail.com.

How often do you check your social media accounts each week? (Check only one)

Signatures Needed for Permission, Certification, and Release:

I certify that the information in this application is true and correct to the best of my knowledge.

My son/daughter has my permission

My Parent/Guardian has given permission

to participate in The Academy for Scholastic and Personal Success program. I understand that the application information and his/her school transcripts will solely be used for program purposes. The information will be kept confidential.

Signature *

Date *

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