New or Existing Applicant: (Choose "Existing" if this student has previously received an award from the STAR program)
Student's Legal Name:
Date of Birth: (mm/dd/yyyy)
Gender:
Grade Level: for the 2021/2022 School Year
Student's Address:

Primary Guardian:
Guardian's Phones:
Guardian's Email:
An email address is required. If you do not have an email account, click the asterisk to create a free Yahoo email account.
Secondary Guardian:

Please Note:

The STAR Program staff will be authorized to communicate only with the guardian and additional contact person entered here.