SACRAMENTO RIVER DISCOVERY CHARTER SCHOOL

APPLICATION FOR ADMISSION — School Year 20_____/20______

STUDENT INFORMATION 

Full Name: _________________________________________________________________  (please circle usual name used)

Birthdate: _______/_______/_______      SS# __________-______-__________     rMale     rFemale

Address_____________________________________________________________________________________________________
                            Street/PO Box                                                                City                                          Zip

Student’s grade  in year applied for ______  Current School:_____________________________________________

Students currently enrolled in 9th, 10th, 11th or 12th must submit high school transcript with application.

Special Interests of Student: _____________________________________________________________________________________

____________________________________________________________________________________________________________

Ethnicity (Optional)
r American Indian/Alaska Native     rAsian/Asian American     rPacific Islander      rHispanic

 rFilipino/Filipino American     rBlack/not of Hispanic Origin    rWhite/not of Hispanic Origin     r Other

Special Services Student is currently receiving:
rTitle I       rSpeech       rRSP       rGATE        r Bilingual Ed        r Indian Ed        r Migrant Ed
No Special Services required: r

Has student ever been expelled from school? _____ Is student currently involved in expulsion process? _____

If yes, from what school? ___________________________________

Home Language Survey:  California Education Code requires schools to determine the language(s) spoken at home by each student.  This information is essential in order for schools to provide meaningful instruction for all students.  Your cooperation in helping us meet this important requirement is requested.

Please answer the following questions.

Which language did your child learn when he/she first began to talk? _______________________

 What language does your child most frequently use at home? ______________________________

Which language do you most frequently speak to your child? ______________________________

Name the language most often spoke by the adults at home: _______________________________

PARENT/GUARDIAN INFORMATION
Father/Guardian Mother/Guardian

Last Name

First Name

Address

Home Telephone

Work Telephone

Cellular Telephone

Occupation

Employer

 Siblings also submitting applications for enrollment:

____________________________________     ________/_______/________      __________ rMale     rFemale
Last Name                           First Name                                              Birthdate                                Grade

____________________________________     ________/_______/________     ___________ rMale     rFemale
Last Name                           First Name                                              Birthdate                                Grade

ADMISSION REQUIREMENTS AND PARAMETERS

Students:

Take responsibility for my own learning and not adversely affect other student’s right to learn
To assist in the maintenance and care of the school and the classroom.
To attend school every day (ten absences per school year is qualification for removal from school).

Parents/Care Providers:

To participate in the learning community of your student by volunteering a minimum of 5 hours per month at the school, working on a designated volunteer project, or a school-related function.
To be responsible for your students transportation to and from school.
To participate in at least 2 conferences per year with your student’s teacher(s).

Attendance at the Charter School is a choice.  If my student does not meet attendance requirements and adhere to the above parameters as well as those listed in the Discovery Charter School Charter, I understand that he/she may be required to return to the district of residence.

 

__________________________________________         ___________________________________________
Signature of Parent/Gaurdian                       Date                          Signature of Student                                 Date

  

                                                                                            

 

Please return completed Application for Admission to:

SACRAMENTO RIVER DISCOVERY CHARTER SCHOOL

1660 Monroe Street • Red Bluff, California  96080