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Millennium 6-12 Collegiate Academy 5803 NW 94th AvenueBroward County Public SchoolsTamarac, FL 33321(754) 322-3948Application for 2021 - 2022 school year(Application Deadline: February 1, 2021) STUDENT INFORMATION Student’s Last Name: _______________________________First Name: ______________________________________Florida Student ID#: ________________________________□ Male □ Female Birth Date: ___________ mm/dd/yyBroward College ID_________________________ Broward College email_______________________(you will get both when you apply at broward.edu)Street Address: ____________________________________City/State/Zip:________________________ _ Home Phone: ( ___ ) ___________________________ Student Cell Phone: ( __ )________________________ Current middle school (2020-2021): _____________________ Current grade (2020–2021): ___________Student E-mail: _____________________________________________________Do you have a sibling currently in 6th-12th grade attending Millennium 6-12 Collegiate Academy? ?____Yes ? ? _____No? Sibling's Last Name:___________________________ Sibling's First Name:__________________Does the student have a parent who is an employee of BCPS? _____Yes ? ?______NoIf yes, provide employee personnel number: ?P_____________PARENT/GUARDIAN INFORMATION With whom does student make his/her permanent home? □ Parent 1 □ Parent 2 □ Both □ Legal Guardian Parent 1 / Guardian □ Mother □ Father□ Legal Guardian Name: ____________________________________________ E-mail: Street Address: ____________________________________City/State/Zip:_________________________ _ Home: ( ___ ) __________________ Cell: ( ___ ) ___________________ Work: ( ___ ) __________________ Parent 2 / Guardian □ Mother □ Father □ LegalGuardian Home address IF DIFFERENT from student: Name: ____________________________________________ E-mail: Street Address: ____________________________________City/State/Zip:________________________ _ Home Phone: ( ___ ) ___________________________ Student Cell Phone: ( __ )________________________SIGNATURES Signing this form authorizes Millennium 6-12 Collegiate Academy staff to access the student’s educational records in preparation for an upcoming meeting. You will be contacted after we receive the application to schedule the meeting. Student signature: _______________________________________________ Date: _____________________ Parent/Guardian signature: ________________________________________ Date: _____________________ Return this completed and signed form to: Millennium 6-12 Collegiate Academy, Attn: Jody Gaver5803 NW 94th Ave., Tamarac, FL. orjody.gaver@062230Applications must be received by Friday, February 1, 2021 to be considered forenrollment for Fall 2021.Applications must be received by Friday, February 1, 2021 to be considered forenrollment for Fall 2021. ................
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