Write the Name of the Charter School for Which You Are Applying: ______

School Use Only:

Date Received:______
Time Received:______
School Official Initials:______

SAN ANTONIOINDEPENDENTSCHOOL DISTRICT

INTERNAL CHARTERSCHOOL STUDENT APPLICATION
For Admission for the ______-______School Year

Instructions: Complete all parts of the Charter School Application and return the completed form to the internal charter school to which you are applying.

Write the name of the charter school for which you are applying: ______

(Please print name of school.)

SCHOOL NAME

SCHOOL ADDRESS

PHONE

GRADES 6-8

Connell

400 Hot Wells Blvd. / 78223

438-6835

Davis

4702 E. Houston St. / 78220

978-7920

Harris

325 Pruitt Ave./78204

228-1220

Irving

1300 Delgado St./ 78207

738-9740

Rhodes

3000 Tampico St./78207

978-7925

Whittier

2101 Edison Drive/ 78201

738-9755

GRADES 4-8

YMLA

545 S.W.W. White Rd. / 78220

228-3070

GRADES K-8

Bonham

925 S. St. Mary’s St./ 78205

228-3300

Hawthorne

115 W. Josephine St./ 78212

738-9795

M.L.King

3501 Martin L. King Dr./ 78220

978-7935

GRADES K-5

Barkley/Ruiz

1111 S. Navidad/ 78207

978-7940

Briscoe

2015 S. Flores St./ 78204

228-3305

Highland Park

635 S. Rigsby Ave. / 78210

228-3335

Please print.

Name of Student:

Gender: Male Female

Date of Birth:

SSN#:

Address:

City/Zip:

Name of Parent/Guardian:

Home Phone:

Work Phone:

Parent’s E-mail:

Grade Level for Requested School Year:

CurrentSchool Services: Special Education Bilingual 504

Sibling currently at charter campus: Yes No If yes, student name:

Grade:

HomeSchool:

School District

Ethnicity: (optional) Hispanic African American White Asian Pacific Islander Native American

Other:

OPEN ENROLLMENT APPLICATION PROCESS FOR

NON-NEIGHBORHOOD STUDENTS

1.The District shall establish the number of open slots available for the next school year based on neighborhood enrollment projections and personnel allocations.

Parents and students may apply for entrance into the charter schools using Form F51-A.
Selection of the students to the open slots will be completed through a lottery system by the District.
The selection lottery shall be open to any SAISD or out-of-District students and be completed before the end of the current school year.
The open enrollment application process does not include enrollment in the Pre-K programs at the charter campuses.

PARENT/GUARDIAN,please read and sign:

We understand that the charter schools at San AntonioIndependentSchool Districtare open to non-neighborhood students only as space allows. The space available at any charter campus will be determined by the District and the space available may vary from year to year. The selection of students for spaces at the charter campuses will be completed by lottery. Parent notification of status will occur as soon as decisions are completed.

We hereby certify that we have read and understand this statement and that the information provided in this application is accurate.

Parent/Guardian Signature:

Date:

For additional information or questions, please call the specific internal charter school campus.

For School Use Only:
Student is: In District Out of District (Need additional FORM F36-A.)
Campus Principal Decision: Approved Denied
Campus Principal Signature: ______Date:______

San Antonio Independent School District does not discriminate on the basis of race, religion, color, national origin, sex, or disability in providing education services, activities, and programs, including vocational programs, in accordance with Title VI of the Civil Rights Act of 1964, as amended; Title IX of the Educational Amendments of 1972; Section 504 of the Rehabilitation Act of 1973, as amended.

Revised July 22, 2015Page 1 of 2FORM F51-A