Grades 3-4 YES Application Form

STUDENT INFORMATION:
Current Grade (2011-12 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
Name of School	City
All acceptance letters will be sent by mail.
SELECT CLASS CHOICE IN ORDER OF PREFERENCE:
Period I Choices:	Period II Choices:



CHECKLIST FOR ALL APPLICATIONS:
completed application form $175 tuition Copy of current report card with comments
MAIL TO:
Minnesota Institute for Talented Youth 1600 Grand Ave. St. Paul, MN 55105 651-696-6590 www.mity.org