Emerson Community Charter Intent to Enroll Form (Residential Students) 2019-2020
This form is for RESIDENTIAL STUDENTS ONLY. A residential student is someone who lives in the Emerson Community Charter boundaries. Only fill out this form if Emerson Community Charter School is your home school. If you are unsure, go to
http://rsi.lausd.net/ResidentSchoolIdentifier to identify your home school. COMPLETING THIS FORM WILL NOT ENTER YOU INTO THE LOTTERY.
Does the student live within the attendance boundaries of Emerson? *
Required
Student Information
Please complete the information below for one student. If you have twin students, please complete one interest form per student.
Student Last Name *
Your answer
Student First and Middle Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Identify the grade student will be during first year of intended enrollment at Emerson. *
Current School of Enrollment (Residential Students) *
Required
Parent/ Guardian Contact Information
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Parent/Guardian Email Address *
Please make sure you have listed the correct email address, most of our communication will be done via email.
Your answer
Resdential Address
This address will be used to determine residential status within Emerson boundaries.
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
The School of Advanced Studies is a program designed for Gifted (GATE) and High Achieving Students. Are you interested in the School of Advanced Studies? * Placement in the school of advanced studies is dependent on supplemental information. *
Placement in the School of Advanced Studies is dependent on an application and supplemental information. Please complete the separate SAS application if you check "Yes" below.
Required
Parent/Guardian Statement
I understand that, upon acceptance into Emerson, 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 .

Under penalty of perjury, by electronically signing below, I certify that all information provided on this Intent to Enroll Form is true and accurate and we agree to adhere to Emerson Middle School Community Charter expectations. I have read the above agreement and accept the terms and conditions.

Parent/Guardian Electronic Signature *
Your answer
All applications must be received by midnight, April 15th.
Emerson is a Los Angeles Unified School District affiliated charter school. Emerson 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.

Please make sure all information is accurate and names are spelled correctly before submitting.
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