2009 Admissions Application

The KMHS Academy of Mathematics, Science & Technology offers an accelerated and advanced curriculum in math, science, and technology. In order to apply, students must be eligible to attend Cobb County Schools. The application process is highly competitive, and a number of criteria are considered. A screening committee ranks the applicants and makes admissions decisions. Successful completion of this application by the announced deadline is critical for consideration. Complete all required sections of this application form and submit by December 4, 2009. You may also download a print copy and FAX the form to 678-594-8209, mail it to the Academy office, or bring it to the KMHS front office by the above deadline. Late applications will not be accepted.
Name: 


A red asterisk (*) indicates required questions.

  1. Last Name*


  1. First Name*


  1. Middle Initial*


  1. Social Security Number (xxx-xx-xxxx)


  1. Zoned High School*
    KMHS
    Allatoona
    Campbell
    Harrison
    Hillgrove
    Kell
    Lassiter
    McEachern
    North Cobb
    Osborne
    Pebblebrook
    Pope
    South Cobb
    Sprayberry
    Walton
    Wheeler


  1. Cobb County Student ID (Lunch Code)


  1. Street Address*


  1. City*


  1. State*


  1. Zip Code*


  1. Home Telephone (xxx-xxx-xxxx)*


  1. Student Email Address


  1. Date of Birth (MM/DD/YY)*


  1. Age*


  1. Gender*
    Male
    Female


  1. Middle School*
    Awtrey
    Barber
    Campbell
    Cooper
    Daniell
    Dickerson
    Dodgen
    Durham
    East Cobb
    Floyd
    Garrett
    Griffin
    Hightower Trail
    Lindley
    Lost Mountain
    Lovingood
    Mabry
    McCleskey
    McClure
    Palmer
    Pine Mountain
    Simpson
    Smitha
    Tapp
    Private School
    Home School
    Out of State


  1. Current Grade*
    8
    9


  1. Current Math Level*
    Deep/Upper Math
    Accelerated Math I
    Accelerated Math II
    Math 8
    Algebra I
    Geometry
    Algebra II


  1. Current School Address*


  1. Father/Guardian Name*


  1. Father/Guardian Daytime Telephone (xxx-xxx-xxxx)*


  1. Father/Guardian Email


  1. Mother/Guardian Name*


  1. Mother/Guardian Daytime Telephone (xxx-xxx-xxxx)*


  1. Mother/Guardian Email


  1. 8th Grade Science Teacher Name*


  1. 8th Grade Math Teacher Name*


  1. 8th Grade Teacher of Choice Name*


  1. Subject*
    English
    Social Studies
    Target
    Foreign Language
    Counselor


  1. List any academic awards and/or honors that you have received since 6th grade.*


  1. List any leadership positions you have held since 6th grade (Science Olympiad, Academic Bowl, math team, summer programs, etc.).*


  1. List any academic extracurricular activities in which you have participated since 6th grade (Science Olympiad, math team, Odyssey of the Mind, Duke TIP program, other summer programs, etc.).*


  1. List any non-academic extracurricular activities in which you have participated since 6th grade (sports, performing arts, scouts, clubs, etc.).*


  1. List any other exceptional characteristics, qualities, or achievements since 6th grade.*