EAGLE ROCK ELEMENTARY & Magnet Center

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PERMIT REQUEST for 2023-24 school year
SOLICITUD DE PERMISO para año escolar 2023-24

This form is a request for a permit and it keeps your information on file.
This does not guarantee a permit will be issued.
We will determine whether or not permits are issued based on space availability.

Thank you for your patience & cooperation.

Email *

STUDENT NAME / NOMBRE DE LA ESTUDIANTE

DATE OF BIRTH / FECHA DE NACIMIENTO

YYYY

GRADE FOR REQUESTED YEAR / GRADO PARA EL PRÓXIMO AÑO

PARENT NAME / NOMBRE DEL PADRE

HOME ADDRESS / DIRECCION DE CASA

PHONE # / NÚMERO DE TELÉFONO

EMAIL / CORREO ELECTRÓNICO

Reason for request / Razón de la solicitud:

PARENT EMPLOYMENT

CONTINUING ENROLLMENT

SIBLING

CHILD CARE

OTHER (Enter reason below)

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OTHER Reason for request / OTRA Razón de la solicitud:

If requesting a sibling permit, name & grade of sibling(s) / Si solicita un permiso de hermano, ¿cuál es el nombre y grado del hermano?:

Name of current school of enrollment / Nombre de la escuela actual en que está matriculado:

If attending private or charter school, name of neighborhood LAUSD school / Nombre de la escuela del LAUSD de su vecindario:

For classroom placement purposes, please check all that apply / Para fines de colocación en el aula, marque todo lo que corresponda::

Student has been identified gifted (GATE) / El/la estudiante ha sido identificado dotado (GATE)

Student has an Individualized Education Plan (IEP) / El estudiante tiene un plan educativo individualizado (IEP)

Student has a Section 504 Plan / El/la estudiante tiene un plan de la Sección 504

Language spoken at home / Idioma de casa:

Send me a copy of my responses.

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