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