Edward J. Sam Accelerated School of Lafayette Student Application
Thank you for your interest in our school!  Please make sure to complete all areas of this online application before submitting.  A valid email address must be entered.
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Parent Email  (All information will be sent to this email address.  Please check it frequently) *
Students and parents will be required to attend orientation via Zoom and acknowledge all policies and procedures. Failure to do so will remove your child from the application process. * *
Student's Last Name *
Student's First Name *
Student's Current Grade Level *
Student's Current Age *
Student's Birth Date *
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Student's Gender *
Student's Race *
Student's Home School *
Are you currently enrolled in a high school academy? *
Student's Home Address *
Student's Home Zip Code *
What is the primary language spoken at home? *
Does The Student Reside With His/Her Mother? *
Mother's Name *
Mother's Cell Phone Number *
Mother's Work Phone Number
Mother's Home Phone Number
Does The Student Reside With His/Her Father? *
Father's Name
Father's Cell Phone Number
Father's Work Phone Number
Father's Home Phone Number
Does the Student Have a Guardian Who Is Not the Mother or Father? *
Guardian's Name
Guardian's Cell Phone Number
Guardian's Work Phone Number
Guardian's Home Phone Number
Has this student ever been home-schooled? *
If YES, what years/grades?
Has this student ever been retained? *
If YES, what grades?
Does the student have allergies or medical concerns *
If YES, please list any allergies and/or medical concerns:
What is the student's current diploma track? *
Please list below the names, relationship and contact numbers for anyone who is allowed to check-out and/or pick up your child from school *
Please indicate your preferred session time  (If you are applying for the "Remote Learning" option please choose an additional time slot) - students must adhere to the assigned session time.  The remote learning option is only available during the traditional school year (August 11, 2022 through May 25, 2023) for those who qualify.  NOTE:  Some students may be required to attend both sessions, based on academic need. All students under the age of 16 must attend the full day session. *
Transportation - Please click all that apply *
Required
Are there any legal/custody concerns regarding this student? *
If YES, please explain - NOTE: original court papers, with the court seal, must be provided to the school in any sole custody arrangements
Why are you applying to E. J. Sam? *
Please let us know any other information you feel is relevant for us to offer maximum support to your student
How did you hear about E.J. Sam? *
ACKNOWLEDGEMENT:  I have completed this application accurately to the best of my knowledge - Please type your name in the box *
ACKNOWLEDGEMENT:  I understand my student must continue to attend his or her base school until all enrollment requirements are completed, if the student is accepted.  Please type your name in the box *
ACKNOWLEDGEMENT:  I understand that I am invited to contact the school, with any questions, at the numbers or email addresses provided on page 1 of the orientation presentation that was emailed to me - Please type your name in the box *
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