Student's First Name

Student's Last Name

Select one
MaleFemale

Age

Applying for
5th Grade6th Grade

School Currently Attending

Will student qualify for Free or Reduced Federal Meal Program?
YesNo

Is student a current or former recipient of the Step Up for Students (formerly PRIDE) scholarship?
YesNo

Will student qualify for the Step Up for Students scholarship?
For more information on income guidelines, please click here: www.stepupforstudents.org OR www.aaascholarships.org

YesNo

Guardian Contact Information (mother, father, other)
First and Last Name
MotherFatherOther
Daytime Phone
Evening Phone

Additional Guardian Contact Information (if applicable)
First and Last Name
MotherFatherOther
Daytime Phone
Evening Phone

Mailing Address
Street
City
Zip

Email Address

How did you hear about Academy Prep Center of St. Petersburg?

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