OTA Student Referral/Application Form

 
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 FIREFOX OR CHROME must be used for application 
Thank you for applying to On Track Academy. All required fields are marked with an *. Your application will be forwarded to the appropriate OTA counselor. Please allow one week for a reply. Application does not guarantee enrollment. All students will be screened based on three criteria: current credit level, high school state test scores, and student conduct history. Student should continue with current academic plan until notified of application status.

 
1.
*
(all text boxes expand to accommodate answers)
 
   
2.
*
(Please provide a physical address where student can receive mail)
 

 

 

 

 
   
3.
*
  Select Date
mm/dd/yyyy
   
4.
*
 
*


    
   
5.
 
   
6.
*
 
   
7.
*
(If enrolling in summer, list grade student is entering)
 
   
8.
 
   
9.
*
Select no more than 1.
 
  
  
  
   
10.
 
   
11.
*
 

 

 
   
12.
*
If not applicable, put "N/A" and a brief explanation.
 
   
13.
 
   
14.
*
 
   
15.
 
   
16.
 
   
17.
 
   
18.
 
   
19.
 
   
20.
*
 (99)
Enter how many credits student has earned to this date.
The value must be between 0 and 26, inclusive.
 
   
21.
*
Enter applicable scores from the following WA state standardized tests. Enter NS for no score. Enter the STATE NAME if you took a standardized test in another state.
 

 

 

 

 

 
   
22.
*
 
  
  
  
  
  

    
   
 
 
 
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