CCSA Intent to Enroll for 2017 - 2018
Please complete all of information on this form in order for your child to be considered for enrollment for the 2017-2018 school year.
~ Complete the full survey separately for each child.
~ By completing this form your child will be entered into a lottery for open seats for the 2017-18 school year.
~ Completing this form DOES NOT guarantee your child's enrollment.
~ You will be contacted if a seat is available for your child.
~ Once contacted, you will have 7 days to complete a Full Enrollment application in order to secure your child's seat.
~ If you do not submit the completed Full Application and supporting documents within 7 days, your child's seat will be given to another student.
Student First Name
Your answer
Student Last Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Current Age
Your answer
Ethnicity
Current School/Daycare
Your answer
Current Grade for 2016-17 (This year)
Grade Applying for 2017-18 (Next year)
Does your child currently receive Special Education Services based on an Individualized Education Plan (IEP)?
Home Address (Street)
Your answer
City
Your answer
Zip Code
Your answer
1st Parent/Guardian's Name (First Name_Last Name)
Your answer
Relationship to Student
1st Parent/Guardian's Home Phone
Your answer
1st Parent/Guardian's Cell Phone
Your answer
1st Parent/Guardian's Email Address
Your answer
2nd Parent/Guardian's Name (First Name_Last Name)
Your answer
Relationship to Student
2nd Parent/Guardian's Home Phone
Your answer
2nd Parent/Guardian's Cell Phone
Your answer
2nd Parent/Guardian's Email Address
Your answer
How did you hear about CCSA?
Anti-Discrimination Statement
The Chester Charter School for the Arts does not discriminate against any person on the basis of race, sex, color, religion or any other classification protected by law in the administration of its education and admission policies.
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