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TECCS Titan for a Day-Middle School-Application
Middle school students in 5th grade-8th grade are invited to spend a day with our students and staff. Students will be paired up with a member of our student government.
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Student First Name
*
Your answer
Student Last Name
*
Your answer
Current grade:
*
Choose
5th grade
6th grade
7th grade
8th grade
Current School:
*
Your answer
Parent First and Last Name:
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Your answer
Cell Phone Number:
*
Your answer
Work Phone Number:
*
Your answer
Emergency Contact Number
*
Your answer
Email
*
Your answer
Please select a first choice date: (must be at least one week in advance)
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MM
/
DD
/
YYYY
Please select a second choice date: (must be at least one week in advance)
*
MM
/
DD
/
YYYY
How did you hear about this program?
Friend or family
Recruiting or education event
Meet the Charters
Facebook/Twitter
Other:
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