Student Application Form
2016 - 2017
Student Name: ___________________________________________________ Grade: ____________
Current School: _____________________________________________________________________
If affected by redistricting, please indicate school to be attended 2016-2017:_____________________
Parent/Guardian: ____________________________________________________________________
Mailing Address: ____________________________________________________________________
Primary Phone: ____________________ Email: ___________________________________________
ESSAY PROMPTS
Directions: Please respond to both of the following essay questions on separate sheets of paper. Do not
include any identifying information such as your name or the name of your school in the body of
the essay. Each essay should be typed or clearly handwritten by the student. Drawings, illustrations,
diagrams, models and/or digital products may be included as well.
1.
2.
You’ve been hired at a video game design company. They’ve put you in charge of creating a
brand new, original virtual world for a game. Your world needs to be different than any typical
ecosystem or city here on earth. Describe the world you will create and who might live there.
(You may want to consider geographical features, climate, life forms, resources, etc.)
Write a letter to yourself to be opened in 10 years. What is a favorite memory you might
want to remind yourself about? What do you think your life will be like? What goals and
dreams have you accomplished? Do you have any advice for your future self?
Please return both essays, along with this Application Form to your Gifted Coordinator.
Permission: Your signature below indicates consent for your child to apply to the 212° Academy.
This selection process will include collecting current assessment data at your child’s home school, as
well as additional testing in math and science.
Parent/Guardian Signature: _________________________________________________
Student Signature: ________________________________________________________
Please return this Application Form to your child’s school by Wednesday, March 30, 2016.