TAFT CHARTER HIGH SCHOOL

Open Enrollment/Intent to Enroll 2017-2018 Form

Student Information

Last Name: / First Name: / MI:
Date of birth: / Grade entering in Fall of 2017:
School Currently Attending:

Parent/guardian contact Information

Parent/Guardian #1: / Relationship to Child:
Street:
City: / State: / ZIP Code:
Phone #1: ( ) / Phone #2: ( )
Phone #3: ( ) / Email:
Parent/Guardian #2: / Relationship to Child:
Street:
City: / State: / ZIP Code:
Phone #1: ( ) / Phone #2: ( )
Phone #3: ( ) / Email:

aDDITIONAL information

Does the student live within the attendance boundaries of Taft Charter High School? ☐Yes ☐No
Does the student live within the boundaries of the Los Angeles Unified School District? ☐Yes ☐No
Does the student have any siblings who are currently attending Taft Charter High School and who will attend the school next year?
☐Yes ☐No If yes, please list name(s):
Does the student have Special Education Services (IEP/504)? ☐Yes ☐No

Parent/Guardian Statement

I understand that, upon acceptance into Taft Charter High School, a birth certificate or acceptable equivalent, proof of residence, proof of guardianship (if applicable), immunization records, and other applicable student records must be submitted as necessary for verification and enrollment purposes.
I understand that any false or incorrect information on this application could jeopardize my child’s enrollment should he/she be selected to attend Taft Charter High School.
I certify that all information provided on this Intent to Enroll/Lottery Application formis true and accurate.
Parent/Guardian Signature: ______Date: ______

All applications must be received in the attendance office of Taft Charter High School

before March 30, 2017 at 4:00 pm.

Taft Charter High School is a Los Angeles Unified School District affiliated charter school. Taft Charter High School does not discriminate against any student on the basis of disability, gender, gender identity, gender expression, nationality, race or ethnicity, religion, sexual orientation, or any other characteristic that is contained in the definition of hate crimes set forth in Section 422.55 of the California Penal Code.

The Los Angeles Unified School District does not provide transportation for students based on

admission to a District affiliated charter school.

FORM - 01/20/17