Small Eagle Eagle's Nest
The Outdoor Academy Application

Spring 2008 Semester
Experiential education for young people, promoting the natural world, and the betterment of human character.
Information provided in this application will be kept confidential.
Please complete this application only if you are applying to OA and ready to pay the $75 fee.
Click HERE to Request Information

Student Information:

Legal Name:
First: Middle: Last:
Nickname: 		Gender:
Birth Date:
,
Age at Arrival:
Home Address:
Street/PO Box:
Address:
City:
State: Zip: 		Telephone: 1 - - -
Student lives with:
Student's email address:
School:
Street/PO Box:
City:
State: Zip: 		Grade Finished in 2007:
Advisor's Name:
Advisor's Phone #: 1 - - -

1st Parent/Guardian Living with Student:

Parent or Guardian Name:
First: Last:
Email:
Frequency of use:

Relationship to Child:
Cell Phone: 1 - - -
Occupation:
Work Phone: 1 - - - ext.

2nd Parent/Guardian Information (if applicable):

Name:
First: Last: Email:
Frequency of use: 		Relationship to Child:
Cell Phone: 1 - - -
Occupation:
Work Phone: 1 - - - ext.
Complete for 2nd Parent/Guardian if Different from Student's Home Address

Street/PO Box:
Address:
City:
State: Zip:

Home Phone:
1 - - -

Helpful Information for Eagle's Nest Staff

1. How did you learn about The Outdoor Academy?
List Other:
2. If referred by a friend, please list their name:

3. Have you ever been suspended or expelled from school?
If yes, please explain:
4. Are you eligible to return to your school?
If no, please explain:

5. Are you receiving financial aid from your school?
6. Do you intend to apply for financial aid from The Outdoor Academy?

7. Is your school on a block schedule?
8. List the courses you are taking this year and specify level where it's appropriate:
Course 1 and Level:
Course 2 and Level:
Course 3 and Level:
Course 4 and Level:
Course 5 and Level:
Course 6 and Level:
9. What courses do you plan to take next year at The Outdoor Academy?
NOTE: This is not a final course sign-up.
means the course is required.
English Natural Science
Mathematics



Level
or Independent Study - Please specify: 		The Arts

10. Please rate your interest in the following outdoor activities (on a scale of 1-4, 1 being the highest).

Whitewater Canoeing Backpacking
Rock Climbing Caving
11. Physical or emotional conditions or other needs that require special attention:
Note: The Outdoor Academy faculty and medical staff are not trained to handle students with severe physical, emotional or psychological disabilities or severe learning disabilities.
12. Has your child received counseling or therapy?
Please explain:
I will use this email address for the PayPal payment:
I have reviewed the information above and agree that is is correct.