Hive Master Mind Application Form

Hive Mastermind University -
Student Intake Form
Student Information
1. Full Name:
________________________________________________
__
2. Date of Birth: _______// (dd/mm/yyyy)
3. Gender: __ Male __ Female __ Prefer not to say __ Other:
________________
4. Current School Grade:
__________________________________________
Parent/Guardian Information
5. Parent/Guardian Full Name:
______________________________________
6. Relationship to Student:
_________________________________________
7. Contact Number:
_______________________________________________
8. Email Address:
________________________________________________
Home Address
9. Street:
____________________________________________________
___
10.City:
________________________________________________
________
11. State/Province:
_______________________________________________
12. Postal Code:
________________________________________________
_
Emergency Contact Information
13. Emergency Contact Name:
______________________________________
14.Relationship to Student:
_______________________________________
15. Emergency Contact Phone Number:
______________________________
Educational Background
16. Current School Name (if applicable):
_____________________________
17. Preferred Learning Style (Visual, Auditory, Kinesthetic, etc.):
_________
18.Does the student have any specific educational needs we
should be aware of (IEP, 504, etc.)? Yes / No. If Yes, please
specify: ________________
Interest in Entrepreneurship and Business
19. Why does the student want to participate in Hive Mastermind
University's program? (Parent/Guardian can assist in answering
this question)
Availability
20. Preferred Program Start Date:
___________________________________
21.Can the student commit to the full duration of the summer
program? Yes / No
22.Will the student be able to attend weekly in-person field
trips? Yes / No
Additional Information
23. Is there any additional information we should know about the
student to best support their learning and participation in our
program?
Parent/Guardian Consent
I, _________________________ (parent/guardian name), certify
that the information provided is accurate and complete. I
understand that this application does not guarantee a place in the
Hive Mastermind University program. I grant permission for my
child's application to be reviewed by the Hive Mastermind
University admissions committee.
Parent/Guardian Signature:
___________________________________ Date: _______//
Please note that you may need to add or modify fields based on
your specific requirements and local laws and regulations,
especially those relating to privacy and data protection. It may be
necessary to consult with a legal advisor to ensure the form
complies with all relevant legal requirements.