Davenport Community School District

Academy West…Business Career Academy

West High School w 3505 West Locust Street w Davenport Iowa 52804 

Phone (319)386-5500

 

 

Academy Application

Name_____________________________________________ ID#_______________________

 

Address_____________________________________________________ ZIP____________________________

Soc. Sec. #_______________________________ Grade____________________ Age _____________________

Current School__________________________________ Date of Birth _________________________________

Parent/Guardian #1____________________________Work Phone ______________ Home Phone______________

Parent/Guardian #2____________________________Work Phone ______________ Home Phone______________

Candidate’s ethnic origin (optional)

___________African American                       __________Asian American                            __________Other

___________Caucasian                                    __________Native American

___________Hispanic                                       __________Multiracial

 

 List activities and/or school sports in which you have or are participating:

 

 

 

 

 

 

List any work or volunteer experience you have had:

 

 

 

 

 

Approximately how many days have you been absent from school this year? (circle one)

Perfect attendance               less than 5 days                   5- 10 days                              more than 10 days (please explain)

 

 

Academy Application

Page 2

Please write a short paragraph to answer each question given below. Answer in complete sentences, using your best English skills.

1. What are your future career goals or plans?

 

 

 

 

2. How would you describe yourself?

 

 

 

 

3. Why would you like to become a part of the Academy?

 

 

 

 

 

List two teachers who know you well enough to give you references.

 

 

 

List any other students you know who might be interested in receiving an application.

 

 

 

 

 

I understand that I am making an application for Academy West and that I may be asked to appear for a personal interview. I further understand that students who are accepted must make a one-year commitment to the Academy.

 

___________________              ___________         _______________________

Student Signature

Date

Parent/Guardian’s Signature

 

  (Back to BAC)