Scintilla Charter Academy 2017-2018 New Scholar Application
Please complete the following application as thoroughly as possible. If contact information changes, please be sure to contact the school to update that information.
Scholar's First Name: *
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Scholar's Middle Name:
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Scholar's Last Name: *
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Scholar's Preferred Name: *
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Date of Birth: *
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DD
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YYYY
Age: *
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Gender *
Grade Applying For: *
Home Address: *
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City: *
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State: *
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Zip Code: *
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Does this child have a sibling who is also applying for the 2017/2018 school year? *
If Yes, please list the names & grades of all children (siblings) you are applying for. A sibling is defined by a child who shares one or both parents. Failure to report siblings during the initial application may prevent sibling priority.
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Full Name of Parent/Guardian: *
with whom the scholar lives
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Home Phone Number:
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Cell Phone Number: *
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Preferred Phone Number: *
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E-mail Address: *
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Relationship to Scholar: *
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Employer: *
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Work Phone Number:
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Full Name of Parent/Guardian #2:
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Address:
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City:
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State:
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Zip:
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Preferred Phone Number:
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E-mail Address:
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Employer:
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Work Phone Number:
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Alternative Contact Name: *
Please provide any alternative contact you would like us to reach out to should your child be offered a spot and we are unable to reach you.
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Alternative Contact's Relationship to Scholar: *
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Alternative Contact's Preferred Phone Number: *
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By signing below, I acknowledge that I have the legal right to enroll this child in school. I also acknowledge that this application does not guarantee admission to Scintilla Charter Academy and that I have read and understand the enrollment, lottery, & wait list procedures for the 2017-2018 school year. *
Please type your name below--this will serve as your official signature. Enrollment, lottery & wait list procedure can be found at http://www.scintillacharteracademy.com/enroll-at-sca.html.
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