iChallengeUth Application Form - futurePREP'd Enrollment

Middle School Academy Application Form

Program Information:

Middle School Academy will participate in the West Michigan Design Challenge this year. Participating schools will set one meeting day a week for 2 hours after school for the weeks of September 15th- December 15th.

This program is targeted for middle school students and modeled off of our high school academy program. Teams will use design thinking to solve a real world challenge, hear from experts in the field of design, learn about a variety of careers, and compete with other teams across West Michigan. If you have any questions, please reach out to dsmyk@oaisd.org

There is a $25 course fee to participate. Financial assistance is available for qualifying families. To inquire contact dsmyk@oaisd.org before starting the application.

* First Name

Middle Name

* Last Name

* Date of Birth

* Address

* City

* State

* Zip Code

* Cell Phone

If the Student does not have one, then enter a Parent's

* Student's Email

Home Phone

* Parent/Guardian First Name

* Parent/Guardian Last Name

* Parent/Guardian Relationship

* Parent/Guardian's Email

* Emergency Contact Phone

* Emergency Contact Relationship

* T-Shirt Size

(adult size)

* School

* Current Grade Level

* Referring Teacher Name

Referring Teacher Email

* Describe your interests and passions

Please list any Allergies/Food Allergies/Health Concerns

Release of Photograph and/or Name: If selected to participate in the futurePREP’d program, I give permission for Ottawa Area Intermediate School District (OAISD) and it’s futurePREP’d partner organizations to use photographs or digital images/ recordings for display and/or promotional purposes as and when required, including in print, video or any other format or publication determined by OAISD. I also give OAISD permission to publish my name in conjunction with the use of these photographs or images, and to quote or record statements from me for promotions, advertisements, publicity, and other purposes. I understand and agree that the OAISD may use these images on the Internet, and may copyright or otherwise protect its use of these images.

* Student/Parent agrees to the photograph/name release:

Student/Parent Statement of Commitment: Acceptance into a futurePREP’d program brings with it certain responsibilities for the student, parent/guardian, and the partnering companies/organizations. The futurePREP’d program will offer a variety of opportunities for academic and personal development. Meeting these requirements listed below is essential to success in the program. Responsibilities for the student will include, but are not limited to:

Adhere to proper dress code
Attendance & participation
Professional behavior
All regular school work Is maintained
Positive behavior

***If these responsibilities are not met, program membership may be terminated***

* Student/Parent agrees to the futurePREP'd commitment:

Transportation Permission: Upon drop off at your child's designated location, the team will have an OAISD-approved vehicle to transport students for various field trips/lunch/other outings as needed. I hereby grant permission for my child to ride in OAISD transportation with an OAISD-approved driver during the program. I agree to assume all risks associated with any group transportation, including but not limited to risks of injury, property damage, and loss; as well as not holding the District responsible for any injuries, damages, or losses that may occur during the course of any group transportation.

* Parent agrees to transportation permission:

Please either enter your Scholarship Code or enter your credit card information to pay the $25 charge.

Scholarship Code

Credit Card Number

Credit Card Security Code

Expiration

First Name on Card

Last Name on Card

Billing Address

City

State

Zip Code

Withdrawal/Cancellation Policy:

If for any reason you must withdraw your application, please notify us as soon as possible by emailing futureprepd@oaisd.org or call (616) 738-8950 x4034.

* - Required Value

The OAISD does not discriminate on the basis of race, color, religion, sex, national origin, age, height, weight, marital status, handicap, disability, or limited English proficiency in any of its programs or activities. The following office has been designated to handle inquiries regarding nondiscrimination policies: Human Rights Officer, Human Resources Department – Ottawa Area Intermediate School District – 13565 Port Sheldon Street Holland, MI 49424 – 1-877-702-8600 (toll free)