Genesis High School Application

GENESIS HIGH SCHOOL APPLICATION

~Please Print Clearly~

Last Name ______First Name______MI______

Grade _____ Age_____ Date of Birth ______Student’s School ID ______

Address (where student currently resides):

Street address: ______City & Zip Code______

Home Phone #______Student Cell #______

Student E-Mail address ______

Do you currently have a job? YES / NO If yes, where? ______

Work address: ______

Supervisor’s Name(s) ______Work #______

What are your current work or shift hours? ______

Are you currently enrolled in school? YES / NO If yes, where? ______

If not enrolled, when were you last in school? ______

Have you spoken to your high school counselor / administrator about this application? YES / NO

Why did you leave school if no longer enrolled? ______

______

v  Do you understand that you will have the privilege of earning a Genesis High School Diploma and thereby realize that by signing this document you are agreeing to the fact that you will not be able to return to Bastrop HS or Cedar Creek HS unless recommended to do so by the Genesis and BHS/CCHS Principals?

o  Initial here if in agreement: _____

Parents / Guardian Name (s) ______Work #______

Address (where responsible parent / guardian currently resides):

Street address: ______City & Zip Code______

Home Phone #______Parent / Guardian Cell ______

Parent / Guardian E-Mail address: ______

Other Contact Phone #’s or emails ______

GENESIS HIGH SCHOOL APPLICATION pg. 2

Genesis High School Optional Flex School Day Attendance Program

Application

OFSDP

I ______give my permission for my

child ______to be on the “Optional Flex School Day Attendance Program”. I understand my child must be at school 90% of all school days to receive credit for attendance and their courses.

Parent/Guardian Signature ______Date ______

Student Signature ______Date ______

Foreign Language Substitution

Students entering high school in 2014 – 15 school year are required under the Foundation HSP to have two consecutive years of a Foreign Language unless in completing the first credit of LOTE, they demonstrate that they are unlikely to be able to complete the second credit. The student may substitute another appropriate course (World Geography).

LOTE 1 Teacher Signature ______Date______

Sending Principal/Designee Signature ______Date______

Parent/Guardian Signature______Date______

This part of the application must be completed by the sending high school prior to enrollment at Genesis HS.

To enroll at GHS all students must have a completed Enrollment form, a Proof of Residency, a copy of Social Security card and a copy of Birth Certificate.

For official use only:

Enrollment Form _____ (POR) Proof of Residency _____ Birth Certificate _____

Social Security _____