Request for Enrollment
Please fill out this request for enrollment for Hart-Ransom Academic Charter School. We will contact you soon!
Parent First Name *
Please list the parent or legal guardian first name
Your answer
Parent Last Name *
Please list the parent or legal guardian last name
Your answer
Parent Email Address *
Your answer
Parent Phone Number *
Please use format: xxx-xxx-xxxx
Your answer
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
County of Residence *
Today's Date *
MM
/
DD
/
YYYY
Year Enrolling: *
Please select the year you would like to enroll at Hart-Ransom Academic Charter School:
Required
Number of Students to Enroll *
Select the number of students you would like to enroll
Program of Interest *
Please select the program/s you wish to use for your students
Required
Student Information
Please list the FIRST and LAST name, GRADE level and BIRTHDATE for each student you wish to enroll.
Click return after each student is added. (SEE EXAMPLE BELOW)
John Smith - 5th grade - 3/07/07 (*click return/enter)
Jane Smith - 2nd grade - 4/08/10
Student Information *
Your answer
Please list each student's name and his/her current school of enrollment.
Click return after each student is added. (SEE EXAMPLE BELOW)
John Smith - Little Red Schoolhouse (*click enter/return)
Jane Smith - Little Red Schoolhouse
JIm Smith - Not in School yet
Current School *
Your answer
Are the student/s in good standing with their present school (behavior, academic, attendance, etc)?
Please explain situation below for any student who is NOT in good standing.
Be sure to include entire name of student in explanation
Good standing? *
If no, explain situation
If not in good standing, please explain situation (include name, date, and situation)
Your answer
Special Needs & Assessments
Does any child have a 504 Plan? *
Do any of the children listed above have a 504 Plan in place
If yes, please explain 504 Plan
NOTE: Parent will need to provide a complete copy to school prior to enrollment if answering yes to 504 Plan
Your answer
Special Education/IEP *
Have any child/ren listed above ever been tested / enrolled in special education?
If yes, select type of IEP
Parent will need to provide a complete copy to school prior to enrollment if answering yes to IEP
If yes, describe IEP
Please list the student name and explain the IEP situation for any child listed above ***A copy of IEP must be submitted with pre-enrollment (you may fax, email, hand delivered to school)
Your answer
Homeschool Instruction Environment
Homeschool experience *
Required
Homeschool experience explained
Your answer
Choosing to homeschool *
Please describe the reasons you would like to homeschool with Hart-Ransom Academic Charter
Your answer
Standardized Assessments
Each year, Hart-Ransom Academic Charter School administers assessments. It is our expectation that all students participate.
Standardized testing participation *
My child will participate in standardized testing
If no, explain assessment situation
Please explain why your student could not participate in assessments. Is there anything that would prevent your child/ren from participating in these assessments?
Your answer
One last question...
How did you hear about us? *
Referred by:
If you have a friend at HRACS please list their name below
Your answer
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