2013-14 Application for Enrollment | Forms | Community Roots Academy

2013-14 Application for Enrollment

Fields marked * are required

STUDENT INFORMATION
Grade in which Presently Enrolled	Grade in 2013-14
Last*	First*	Middle	Other Name/Nickname
Date of Birth*	Place of Birth (City, State & Country)		Gender*
Street Address*	Apt #	City*	Zip Code*
Home Telephone #	Current District and School Attended		Student Lives With...

FAMILY INFORMATION
Mother / Legal Guardian			Father / Legal Guardian
Last Name	First Name		Last Name	First Name
Home Phone	Mobile/Pager		Home Phone	Mobile/Pager
Email Address			Email Address

SIBLING INFORMATION A completed application is required to reserve sibling preference (If space is available).
	Name	Age	Grade	Current School	Current CRA Student	Applying to CRA
1:					YES NO	YES NO
2:					YES NO	YES NO
3:					YES NO	YES NO

PREVIOUS SCHOOL/PROGRAM INFORMATION (Include preschool, childcare, and early intervention if applicable).
	Previous School / Programs Attended	City/State	Dates Attended	Grade Levels	Capistrano Unified School District
1:					YES NO
2:					YES NO
3:					YES NO

SPECIAL SERVICES
A	Did student ever have an Individualized Education Program (IEP) at his/her previous school?	YES NO
B	Did student have a Section 504 Plan at his/her previous school?	YES NO
C	Does student have difficulties that interfere with his/her ability to go to school or to learn?	YES NO
D	Has this student been identified for gifted and talented educational services (GATE)?	YES NO
E	Has anyone ever suggested that your child be assessed or tested?	YES NO
	If yes to "E", who and what were the reasons?

FORM SUBMISSION RECEIPT
Your Email Address* This is required to send you confirmation that the form was successfully submitted and your information has been received.
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By submitting this form I verify that the above information is true and correct.