DSA Enrollment Application Form

Student Application Form

Dolphin STEM Academy Full-Time Online Private School
Student Name *

First Name Middle Name Last Name
Birth Date *

Month Day Year
Gender *
Anticipated start date at Dolphin STEM Academy *
Last Grade Level Completed *
Upload student documents

Browse Files
Transcripts, report cards, immunization/exemption records, 1 individual photo of the student, and relevant school reports Cancel of

Student's Home Address *

Country *
Student's STEM area(s) of interest *
Additional comments/information about the student
Parent/Guardian Name *

First Name Last Name
Parent/Guardian Email *
Mobile Number *

- Area Code Phone Number
Phone Number

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

Jen Mackinnon, Working Homeschool Mom/Practical by Default Facebook Ad Dolphin STEM website
Date Reservation *
Select a time range for your conference call *
Your time zone *
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 in your care. Furthermore, you agree to the terms of service and to provide tuition and fees payment for enrollment upon admission.
Signature *

Use your mouse/cursor to sign electronically. Clear
Should be Empty:

Student Application Form