INNOVATIVE PROGRAM ONLINE APPLICATION

APPLICANT CONTACT INFORMATION

Student ID Number:     Student Gender:   Choose below Male Female

Student's Last Name:     First Name:     Middle Initial:

Parent's Last Name:     First Name:     Middle Initial:

Your home address:

Street Address City, ST ZIP

Your current telephone numbers:   Day    Evening

Parent's Email Address:

ACADEMIC INFORMATION

Current Elementary School Where Your Child Is Enrolled:  Choose a school below... Central Park Elementary School Mirror Lake Elementary School Peters Elementary School Private School Parochial School Other - Not Listed Here     Grade Level: 8 7 6 5 4 3

Do you reside within the boundary of Plantation Middle School? Choose below Yes No Not Sure

Reading FCAT Achievement Level:  Choose below Level 3 - Reading Level 4 - Reading Level 5 - Reading

Mathematics FCAT Achievement Level:  Choose below Level 3 - Math Level 4 - Math Level 5 - Math

Thank you for your interest in Plantation Middle School. Please press the Submit Button below to submit your application to our Innovative Program Coordinator. We look forward to providing you with a timely response to your application in the near future.