Student Application Welcome! To apply for a slot at Nerd Academy, please complete this form. Step 1 of 4 25% Student InformationIn this section, we need basic information about your child.What school year are you applying for?(Required)Please choose one.2024-20252025-2026Desired start date(Required)Student's desired first day of school.MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920To what grade is this student applying for?(Required)Please choose one.Pre-KKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEighth GradeStudent's Full Name(Required)As shown on birth certificateIf student has a nickname, enter it here.SuffixNoneJr.Sr.IIIIIIIVVVIVIIVIIIIXXGender at birth.(Required)MaleFemaleRace(Required)American Indian or Alaskan NativeAsianBlack or African AmericanNative Hawaiian/Pacific IslanderWhiteEthnicity(Required)AfricanAlaskan NativeArabicAsianAustralasian/AboriginalChineseCaribbeanCubanEuropean/Anglo SaxonFilipinoGuamanianIndianJapaneseKoreanLatin AmericanMelanesianMexicanMicronesianPacific IslanderPolynesianPuerto RicanOther HispanicUS or Canadian IndianVietnameseDate of Birth(Required)Must match birth certificate.MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Home Language - Primary(Required)The primary language used in the student's home.EnglishSpanishOtherHome Language - SecondaryThe secondary language spoken at home.NoneEnglishSpanish Student BackgroundTell us about any medical conditions and where your child last attended school.Medical Conditions(Required)Does your child have any medical conditions or concerns?NoYesMedical Information(Required)Please indicate any medical conditions.Special Educational Needs(Required)Are there any known or suspected SEN concerns, or previous SEN assessments?NoYesSEN Details(Required)Provide any comments or information concerning your child's development and SEN history.Has your child been a victim of bullying at any previous schools?YesNoDid the bullying affect your child's school performance?NoYesWould you mind sharing details about the bullying incidents and how they affected your child? This is completely voluntary and anything you share will be treated as confidential information.Does your child struggle with any particular subject(s)? Please explain.Please check any special interests your child may have: Coding Robotics Video Production Video Editing Social Media Content Creation Baseball Soccer Football Swimming Volleyball Tennis Pickleball Entrepreneurship Other Has your child attended school before?(Required)If yes, please enter the last two schools your child attended on the next screen.YesNoPrevious SchoolsIf your child has attended more than one school, click the plus sign to add another row.School NameCityGrades Attended Add Remove Family InfoWe just need some basic information on parents or guardians.Parent/Guardian 1(Required) First Last Email(Required) Enter Email Confirm Email Mobile PhoneClick continue if you don't have one.Home/Work PhoneClick continue if you don't have one.Parent/Guardian 2(Required) First Last Email(Required) Enter Email Confirm Email Mobile PhoneClick continue if you don't have one.Home/Work PhoneClick continue if you don't have one.Primary Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Registration Fee(Required)Per Student Price: Total Credit Card(Required) Cardholder Name Card Details Submission DisclaimerWhen you submit a form on our website, we may collect your IP address for security and analytical purposes. This collection assists us in monitoring for fraudulent activities, ensuring the security of our services, and improving user experience. We handle this information in compliance with applicable data protection regulations. Please be advised that any attempts to harass, intimidate, or submit spam will be taken very seriously. We reserve the right to pursue legal action against individuals engaging in such activities. By submitting this form, you agree to the collection and use of your IP address for these purposes and acknowledge that any misuse of this form will result in appropriate legal action. I have read and agree to the terms of the Disclaimer. Δ
