New Designs Charter School

E-mail Login

Student Enrollment Application

Please complete each field. Mandatory fields marked *

Today's Date * :
MM/DD/YYYY
Please select the Academic Year for which you are applying * :
Please select the campus to which you are applying * :
Next year's grade level * :
Has the student ever attended a New Designs Charter School Before? * :
If so, which campus did the student attend? :
Students Legal First Name * :
Students Legal Middle Name :
Students Legal Last Name * :
Other Legal Name (if applicable) :
Mailing Address - Residence/House Number * :
Mailing Address - House/Apartment Number :
City * :
State * :
Zip Code* :

Parent/Guardian 1

Parent/Guardian First Name * :
Parent/Guardian Last Name * :
Parent/Guardian Relation :
Parent/Guardian Home Phone * :
xxx-xxx-xxxx
Parent/Guardian Cellular/Daytime Phone :
xxx-xxx-xxxx
Parent/Guardian Work Phone :
xxx-xxx-xxxx
Parent/Guardian Employer :
Parent/Guardian Email :

Parent/Guardian 2

Parent/Guardian First Name * :
Parent/Guardian Last Name * :
Parent/Guardian Relation :
Parent/Guardian Home Phone * :
xxx-xxx-xxxx
Parent/Guardian Cellular/Daytime Phone :
xxx-xxx-xxxx
Parent/Guardian Work Phone :
xxx-xxx-xxxx
Parent/Guardian Employer :
Parent/Guardian Email :
Secondary Address (If Different from above) :

Is your child's Ethnicity Hispanic or Latino? (A person of Cuba, Mexican, Puerto Rico South Central American, or other Spanish culture or origin, regardless of race) * : Yes No
What is your Child's Race? (Please check up to five racial categories) * :
The above part of the question is about ethnicity, not race. No matter what you selected above, please continue to answer the following by marking one or more boxes to indicate what you consider your race to be.
American Indian or Alaskan Native (100) (persons having origins in any of the original people of North, Central or South America)
Chinese (201)
Japanese (202)
Korean (203)
Vietnamese (204)
Asian Indian (205)
Loatian (206)
Cambodian (207)
Hmong (208)
Other Asian (299)
Hawaiian (301)
Guamanian (302)
Samoan (303)
Tahitian (304)
Other Pacific Islander (399)
Filipino/Filipino American (400)
African American or Black (600)
White (700) (persons having origins in any of the original peoples of Europe, North Africa, or the Middle East)
Other :

Parent Education -- Check the response that describes the education level of the most educated parent. * :
Graduate Degree or Higher (10)
College Graduate (11)
Some College or Associate's Degree (12)
High School Graduate (13)
Not a High School Graduate (14)

Date Student first attended school in the U.S. :
*mandatory if the child's primary home language is anything other than English
(MM/DD/YYYY)
Date Student first attended school in California :
(MM/DD/YYYY)
Date Student first attended school in California :
(MM/DD/YYYY)
Student Gender * : Male Female
Student Birthdate * :
(MM/DD/YYYY)
Student Birthplace - (City) * :
Student Birthplace - (State) * :
Student Birthplace - (Country) * :
Is the Student a U.S. Citizen ? * : Yes No
What language/dialect does your son/daughter most frequently use at home? * :
What language/dialect did your son/daughter learn when he/she first began to talk? * :
What language/dialect do you most frequently speak to your child? * :
Has your child ever been given the CELDT Test (California English Language Development Test)? * : Yes No I don't know
In which language do you wish to receive communication from the school? * :

Residence -- where is your child/family currently living? (federally mandated by NCLB) -- Please check the appropriate box * :
In a single family permanent residence (house, apartment, condo, moblie home)
Doubled-up (sharing housing with other families/individuals due to economic hardship or loss) (11)
In a shelter or transitional housing program (10)
In a motel/hotel (09)
Unsheltered (car/campsite) (12)
Other (15)

Parent/Guardianship Information (with whom the student lives) -- check all that apply * :
Father
Mother
Both
Step-Father
Guardian
Foster/Group Home
Other

Is the above (checked) person(s) the student's LEGAL guardian? -- If no, please complete a "Caregiver Affidavit" Available through the Main Office. * :

If there is a Legal custody agreement regarding this student, please select one * :
Sole Custody
Guardian
Joint Custody
Not Applicable

Most Recent School student Attended (Dates attended - Full School Name - School Address) * Must be completed :

Are there phychological or confidential reports available from your child's former school? * : Yes No
Has your child been suspended? * : Yes No
Has your child EVER been expelled? * : Yes No

What special services has your child received? (Please check all boxes that apply) :
Resource (RSP)
Special Day Class (SDC)
Speech/Language
504
Gifted (GATE)
Remedial Math
Remedial Reading
Counseling
English Language Development
Help to Improve Attendance/Behavior
Other

For High School Students only: If you are a returning student, please select the pathway that you were a part of in the 2010-2011 school year * :
Medical Science
Law & Diplomacy
Information Technology

All NEW incoming and returning students, please select the pathway you would like to be a part of as your FIRST CHOICE for the 2011-2012 school year:
* 1st Choice
Medical Science
Law & Diplomacy
Information Technology

All NEW incoming and returning students, please select the pathway you would like to be a part of as your SECOND CHOICE for the 2011-2012 school year: * 2nd Choice
Medical Science
Law & Diplomacy
Information Technology

By my/our agreement within this document, I/we as Parent(s) or legal guardian of the above named student give permission to the principal of the previous school to release the following mentioned records to New Designs Charter School. * I hereby authorize the release of my child's records in the manner of grades, academic, psychological assessments and notes, disciplinary, attendance, medical/immunization reports, testing results and or evaluations to New Designs Charter School.

Yes No
Did someone refer you from our school ? : Yes No

Please Indicate NDCS student who referred you (Last, First) We would like to Thank the Sudent, that referred you to our school :

Grade Level Student who referred you :

I certified that all the information above is correct * : Yes No

I (Parent/ Guardian) authorize this document * :