Millstone Scholars Application

Page 1

Please select the Millstone Cohort to which you are applying:

Product Code

Please note:

Our teachers would like to communicate directly with applicants and students for the purposes of discussing course work. Please provide contact information for your child below.

Student Information

First Name

Last Name

Phone

Please enter the student's email address

Please confirm the student's email address

Emails do not match

Address

City

State/Province

Postal Code

Country

Date of Birth

Please make sure the correct year is entered.

What grade are you in?

What grade are you finishing this spring?

Gender

MaleFemale

Do you anticipate needing a scholarship for this program?

YesNo

Headshot

Page 2

School Information

Which of the following best describes your current school?

Public SchoolPrivate SchoolJewish Community Day SchoolHomeschool

Which of the following best describes your current school?

Jewish Day SchoolReligious School

Please select the name of your Middle School

If your school is not listed, please select "Other" at the bottom of list.

What is the name of your school?

Parent/Guardian #1 Information

Parent/Guardian #1 Title

Parent/Guardian #1 First Name

Parent/Guardian #1 Last Name

Parent/Guardian #1 Email

Parent/Guardian #1 Phone Number

Address

Please check here if Parent #1 has the same address as the student

Address

City

State/Province

Postal Code

Country

Parent/Guardian #2 Information

Please leave this section blank if needed.

Parent/Guardian #2 Title

Parent/Guardian #2 First Name

Parent/Guardian #2 Last Name

Parent/Guardian #2 Email

Parent/Guardian #2 Phone Number

Address

Please check here if Parent #2 has the same address as the student

Address

City

State/Province

Postal Code

Country

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