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EMPOWER Academy Application

Student Information for HS EMPOWER Academy

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How did you hear about SouthernTech's EmPower Academy?*
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Select the School District You Reside In*
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Race/Ethnicity
Check All That Apply
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Are You a Single Parent?*
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State*
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*Please make sure all phone numbers listed are current and if numbers change, see one of the secretaries in the main office.

Emergency Contact Information

Personal Background Information

Education: Please select the highest grade completed*
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Will you need transportation to SouthernTech?*
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Which of the following (if any) contributed to your leaving school?*
Check All That Apply
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Confidential Information

Are you currently expelled or suspended from any school for violation of school codes regarding fighting, weapons, drugs, or anything else?*
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Have you ever been a resident of a detention center, children's shelter, boy's home, jail, etc?*
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Are you currently under the supervision of a probation or parole officer?*
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