High School Application

Marine Science And Nautical Training Academy
MANTA

High School Student Application (*Required Field)

    Student Applicant Information
    *First Name
    *Middle Name
    *Last Name
    Nickname
    *Email Address
    *Date of Birth
    Country of Citizenship
    *Male/Female
    *Telephone
    *Address
    *City
    *State
    *ZIP
    Passport Number
    Passport Expiration Date


    Parent/Guardian Information
    *Mother's Name
    Home Phone
    Address
    *Email
    Place of Employment
    Work Phone
    *Father's Name
    Home Phone
    Address
    *Email
    Place of Employment
    Work Phone
    *Which parent is first point of contact

    Student Merit/Eligibility Information


    *Do you have parent's approval to participate in the MANTA program
    *High School Name
    *Grade
    *Current GPA
    *List of Science Courses Taken
    *List of Extracurricular Activities
    *Do you intend to go to college
    *If so, what majors are you considering
    *Level of SCUBA certification (no experience necessary)
    *If SCUBA certified, what was the certifying organization (e.g., PADI, NAUI)
    *In 5 sentences or less, describe why you want to enroll in MANTA's program and what do you hope to gain from the experience
    A recommendation is necessary before acceptance into the MANTA program. While the MANTA program is a unique experience, it is physically, socially and academically challenging. Please identify a professor that will provide a recommendation for you. We will contact them using the information you provide below and ask them to complete a short reference form.
    Recommending Teacher Information


    *Have you asked your teacher if they are willing to give you a recommendation
    *Teacher's Full Name
    *Teacher's Affiliation (e.g., School Name)
    *How do you know this teacher (e.g., biology teacher, sport's coach)
    *Teacher's Email

    please complete question to discourage spam:   − 2 = 5