Application

Please fill in the application below AND

Send by mail 2 letters of recommendation from former teachers, counselors or principals AND

Have your counselors send in copies of the 7th and 8th grade report cards and CMT scores to:

Roger C. Legako, counselor, or Gayle Greene, vice principal

Bulkeley High School

300 Wethersfield Ave.

Hartford, CT 06114

Telephone: 728-3300 ext. 274 Fax: 247-3491


Contact Information

Name:

Date of Birth (m/d/y):

Address: Street/P.O. Box

City: State: Zip Code:

Telephone:

Middle School:

 

Parent/Guardian name:

Address: Street/P.O. Box

City: State: Zip Code:

In case of an emergency, contact:

Phone Number:

 

Personal Information (please check) Male Female

Asian African-American Hispanic Caucasian Native American Other

Why do you want to enroll in the Health Professions Center of Excellence?

 

Parent Volunteer Information

As the parent or guardian, please indicate how you could support the Health Professions Center of Excellence.

Guest Speaker Mentor/Advocate Classroom Volunteer Field Trips Publicity/Newsletter

Parent Group Career Fairs

Other

 

About the Academy/Our Past, Present and Future/ UConn Partnership information /Courses of Study /

Academy Photos/ Advisory Board Members

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