Application Form



Student Information

*Please Note: To be eligible for 4-year-old kindergarten, a child must be 4 on or by September 1 of the school year. To be eligible for 5-year-old kindergarten, a child must be 5 on or by September 1 of the school year.

Prior to Our School, the Student has Attended:

Student Housing Information

The answers to the following questions can help determine the services this student may be eligible to receive under the McKinney-Vento Act 42 U.S.C. 11435. The McKinney-Vento Act provides services and supports for children and youth experiencing homelessness.
If you own/rent your own home, you do not need to complete this form.

Ancestry / Ethnic Origins and Tribal Affiliation Data

Parent Information

Primary Parent or Guardian Information

Secondary Parent or Guardian Information

Student's Sibling Information

Emergency Contacts - to be reached when the school is NOT able to reach the parents

Wisconsin law requires that each student provide a certified copy of any child custody order or decree which has been issued with respect to the student. The custodial parent of such a student must also provide the board of education with certified copies of any later court orders which modify the original custody order or decree.

Home Language Survey

As required by federal law, this form must be completed for all students at the time of enrollment. (Title VI Compliance)

Please answer the following questions:

Parent in Military

Request For Records

Permisson to Release Permanent School Records

Milwaukee Math and Science Academy
2703 N. Sherman Blvd.
Milwaukee, WI 53210

Please send the all of the information listed below, if applicable:

  1. Grades & Academic Records
  2. Psychological Assessment & Records
  3. Disciplinary Records
  4. Attendance Records
  5. Medical/Immunization Records
  6. All Testing Results and/or EvaluationsAll Special Education Records/Info (IEP, MFE, Parent Permission, Prior Written Notice, etc.)

Parent permission is no longer required when requested by authorized school personnel. US DEPARTMENT OF EDUCATION; FEDERAL EDUCATIONAL RIGHTS AND PRIVACY ACT. 34 CFR § 99.31

Medical Consent

Emergency Medical Authorization Purpose:

This form is to enable parents and guardians to authorize the provision of emergency treatment for the child who gets ill or injured within the school authority when you are inaccessible.

Medical History

Facts concerning the child’s medical history including allergies, medications being taken, and any physical impairments of which a physician/ school personnel should be informed: (Please Specify Below)

In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for (1) the administration of any treatment deemed necessary by the preferred doctor indicated, or, in the event the designated preferred practitioner is not available, by another licensed physician or dentist; and (2) the transfer of the child to any hospital reasonably accessible.

This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentist, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery.

Internet Access at Home Survey

Parent Permission / Photo Release

From time-to-time Milwaukee Math and Science Academy is fortunate to have news articles related to some of our activities. The coverage may be newspapers or television stations. During this coverage, pictures and /or names of students may be used. From time to time we also use students’ pictures in newsletters, brochures and informational videos of Milwaukee Math and Science Academy. We also publish our school related pictures and illustration on our web site, and or We will permit this as long as the coverage is positive and personal information is not included without your permission.

Immunization Information

Section 3313.671 requires children of school age to be immunized against Varicella (chickenpox), Diphtheria, Whooping Cough, Tetanus, Polio, Rubeola, and Mumps.

** Please provide a COPY of the most recent Immunization records **

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