MADISON COUNTY BOARD OF EDUCATION

BUCKHORN HIGH SCHOOL ENGINEERING ACADEMY

(PROGRAM APPLICATION)

**PRINT OUT FORM AND TURN INTO MR. HANCOCK, ROOM 119**

NAME: ___________________________ (First, Last)

SSN(*Required for Registration)____-___-_______ DATE OF BIRTH__/__/_____

HOME TELEPHONE NUMBER ____________________ (ex..256-555-1234)

ADDRESS_________________________________________________________

CITY _________________ ZIP CODE_______________

PARENT’S NAME _________________(Father) ___________________(Mother)

PARENT’S WORK TELEPHONE

FATHER MOTHER CELL(EACH PARENT)

________________ _________________ ____________/_____________

It shall be the policy of the Madison County Board of Education and the Buckhorn High School Engineering Academy to recruit and select for students the best qualified applicant to participate in the Engineering Academy without regard to race, color, creed, national origin; nor shall any person be denied participation solely because of sex or disability except as provided for by the law or policy.  If you need reasonable accommodations in completing application requirements due to a disability as defined by the Americans With Disabilities Act of 1990, contact the Chair person of the Engineering Academy with Buckhorn High School, 4123 Winchester Road, New Market, AL. 35761.

To be eligible for consideration, I must meet the following requirements:

1. Have a 2.0 academic GPA for the last two available semesters.
2. Have met special requirements for the being chosen into the Engineering Academy with the following:
1. 2 Teacher Recommendations for why you should be selected
2. 1 Counselor Recommendations for why you should be selected.
3. Submit a 1 page essay on why you would like to enter the Engineering Academy.

________________________ ______________________________

(Parent Signature) (Student Prospect Signature)