Dolphin STEM Academy PRIVATE SCHOOL APPLICATION

PRIVATE SCHOOL APPLICATION

Dolphin STEM Academy
Student Information
Name *

First Name Last Name
Birth Date *

Month Day Year
Gender *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Country *
Last Grade Level Completed *
Anticipated start date *
Student's STEM area(s) of interest *
Does this student have an IEP or require special education services? If yes, please explain in detail. *
Additional comments/info about the student
Please upload a current photo of the student (headshot) AND the student's birth certificate and school records (transcripts, report cards, standarized tests, etc). *

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Cancel of
Please note, the student's social security number is required; you will enter the information directly into our student information system during orientation week.
FL RESIDENTS ONLY: The state of Florida requires 2 items: (1) Health Exam completed on Form DH3040 which has been completed within the last 365 days; and (2) proof of immunization which must be completed on Form DH 680 by a Florida physician. For students with a vaccination exemption, the exemption must be completed on Form DH 681 by your Florida county health department. Please upload forms 3040 and DH 680 or 681 if your child is a Florida resident only. For more information, please visit www.floridahealth.gov/programs-and-services/immunization/schoolguide.pdf

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Cancel of
Additional Enrollment

Enroll an additional student.
Do you want to enroll an additional student?

Yes, I want to enroll an additional student. No, I do not want to enroll an additional student.
Student Information

Enroll an additional student.
Name

First Name Last Name
Birth Date

Month Day Year
Gender
Last Grade Level Completed
Anticipated start date
Student's STEM area(s) of interest
Does this student have an IEP or require special education services? If yes, please explain in detail.
Additional comments/info about the student
Please upload previous the student's birth certificate and school records (transcripts, report cards, standarized tests, etc).

Browse Files

Cancel of
Please note, the student's social security number is required; you will enter the information directly into our student information system during orientation week.
FL RESIDENTS ONLY: The state of Florida requires proof of immunization or exemption for all Florida residents. The immunization records must be completed on Form DH 680 by a Florida physician. For students with a vaccination exemption, the exemption must be completed on Form DH 681 by your Florida county health department. Please upload form DH 680 or 681 if your child is a Florida resident only. For more information, please visit www.floridahealth.gov/programs-and-services/immunization/schoolguide.pdf

Upload Files

Cancel of
Additional Enrollment

Enroll an additional student
Do you want to enroll an additional student?

Yes, I want to enroll an additional student. No, I do not want to enroll an additional student.
Student Information

Enroll an additional student.
Name

First Name Last Name
Birth Date

Month Day Year
Gender
Last Grade Level Completed
Anticipated start date
Student's STEM area(s) of interest
Does this student have an IEP or require special education services? If yes, please explain in detail.
Additional comments/info about the student
Please upload previous the student's birth certificate and school records (transcripts, report cards, standarized tests, etc).

Browse Files

Cancel of
Please note, the student's social security number is required; you will enter the information directly into our student information system during orientation week.
FL RESIDENTS ONLY: The state of Florida requires proof of immunization or exemption for all Florida residents. The immunization records must be completed on Form DH 680 by a Florida physician. For students with a vaccination exemption, the exemption must be completed on Form DH 681 by your Florida county health department. Please upload form DH 680 or 681 if your child is a Florida resident only. For more information, please visit www.floridahealth.gov/programs-and-services/immunization/schoolguide.pdf

Upload Files

Cancel of
Parent/Guardian Info
We don't spam and we don't sell info! We use contact information to get in touch with you about your requested service and programs at Dolphin STEM Academy.
Parent/Guardian Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Country *
Email *
Enter the email address to receive login information.
Phone Number *

Area Code Phone Number
How did you hear about Dolphin STEM Academy? *

Dolpin STEM Facebook Ad Dolphin STEM website Jen Mackinnon, Google Ad Other/Referral (Please enter referral name below)
Registration

Payment in Full Option

Registration and Payment:

Private School APPLICATION FEE $ 99.99

Per Family

Private School Enrollment - Sibling discount applies $ 2,999.00

Total # of STUDENT ENROLLMENTS
Item subtotal: $ 0.00

Enter coupon

Total $ 0.00

Submission of Application

Confirm your acceptance and agreement with our school policies.
CURRICULUM POLICY

An enrollment advisor will contact you to discuss our extensive list of courses and provide an orientation to the program. Private school courses are available between August and May of the school year. Please contact us with any questions.
PAYMENT AND REFUND POLICY

We want you to be happy! Payment is required prior to the beginning any courses/assessments. Refunds are available for written cancellations received within 14 calendar days after purchase. All refunds are subject to a $250 cancellation processing fee and pro-rata usage fee. Cancellation requests must be emailed and must include the student's full name, date of birth, enrollment courses, and parent/guardian applicant's name and phone number. To protect the interests of families, refunds will only be issued to the same payee and using the same payment method as the original purchase payment was made.
AGREEEMENT

By signing and submitting this form, you acknowledge that you are an adult age 18 years or older and are completing this form on behalf of a child/minor in your care to participate in our private school program(s). You agree to pay the required course fees for this program/service. Furthermore, you agree to the Terms of Service.
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PRIVATE SCHOOL APPLICATION

Student Information

Additional Enrollment

Student Information

Additional Enrollment

Student Information

Parent/Guardian Info

Registration

Submission of Application