Online Student Application

Student Information

Student Name

School

Grade

PowerSchool Username (your login for grades)

PowerSchool Password (Case Sensitive)

Student Birthday

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Student Email

Student Cell

Student Home Phone

Address

City

State

Zip

Are you signed up for Oklahoma Promise? Yes No Not Eligible

School 1st Choice Select one.. OSU OKWU RSU

School 2nd Choice Select one.. OSU OKWU RSU

School 3rd Choice Select one.. OSU OKWU RSU

Counselor Name

Counselor Email

Teacher Reccomendation 1

Teacher Reccomendation 2

Parent/Guardian 1 Information

Parent/Guardian 1 Name

Parent/Guardian 1 Cell

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Address

City

State

Zip

Employer

Employer Phone

Employer Address

City

State

Zip

Highest Education Level

Ethnicity

Tribal Information (if applicable) optional

Primary Language spoken

Parent/Guardian 2 Information

Parent/Guardian 2 Name

Parent/Guardian 2 Cell

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Address

City

State

Zip

Employer

Employer Phone

Employer Address

City

State

Zip

Highest Education Level

Ethnicity

Tribal Information (if applicable) optional

Primary Language spoken

Legal Release

As the parent or legal guardian of This Student, I understand that I will be requested to release his/her academic and behavior information to my child’s Young Scholars mentor and to other Young Scholars representatives. In addition, I have completely read and understood the criteria for the Young Scholars of Bartlesville and both my child and I agree to comply with such criteria.

Parent/Guardian 1 Digital Signature

Parent/Guardian 1 Digital Signature

Verification Code from image.

Are you a mountebank?