Project Discovery Enrollment Application

Only Alexandria City Public School students are eligible. Please contact the Project Discovery Coordinator, Tashana Pulliam at 571.645.1942 if you need assistance with this application. You will be contacted by Ms. Pulliam after she receives your application.

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* 1. Please enter your contact information.

First and Last Name *

Middle Initial (if you don't have one type N/A)

Address *

Address 2

ZIP/Postal Code - MUST ATTEND ALEXANDRIA CITY PUBLIC SCHOOLS *

Email Address *

Phone Number *

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* 2. Please enter one parent or guardian's contact information.

First and Last Name

Email Address

Phone Number

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* 3. What is your date of birth?

Date

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* 4. How do you identify your gender?

Male

Female

Transgender - Male to Female

Transgender- Female to Male

Doesn't identify as male, female, or transgender

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* 5. How do you identify your race?

American Indian/Alaska Native

Asian

Black/African American

Native Hawaiian or Other Pacific Islander

Other Race

White

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* 6. How do you identify your ethnicity?

Hispanic/Latino

Non-Hispanic/ Not Latino

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* 7. Please indicate if you have a disability.

Disabled

Not disabled

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* 8. What is your grade level?

8th

9th

10th

11th

12th

Project Discovery Enrollment Application

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* 1. Please enter your contact information.

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* 2. Please enter one parent or guardian's contact information.

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* 3. What is your date of birth?

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* 4. How﻿﻿﻿ do you identify your gender?﻿

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* 5. How do you identify your race?

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* 6. How do you identify your ethnicity?﻿

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* 7. Please indicate if you have a disability.

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* 8. What is your grade level?

* 4. How do you identify your gender?

* 6. How do you identify your ethnicity?