GRADES 3-4 YES Online Application - Spring 2010
STUDENT INFORMATION:
Current Grade (2009-10 school year): 3 4 Date of Birth:
Male Female

Last Name

First Name
Middle Initial

Street Address

City/State/Zip

Name of Parents or Guardian

Home Phone
Work Phone

Parent Email
I would like to receive the acceptance packet by email.

Name of School
City
SELECT CLASS CHOICE IN ORDER OF PREFERENCE:
Period I Choices: Period II Choices:
CHECKLIST FOR ALL APPLICATIONS:
completed application form    $170 tuition    most recent report card
MAIL TO:
Minnesota Institute for Talented Youth
1600 Grand Ave. St. Paul, MN 55105
651-696-6590
www.mity.org