Kairos Enrollment Application
IMPORTANT NOTICE:

This form requests information charter schools are required to record if and when they enroll a student.

By law, answers to the questions will not and cannot affect your child's chance at admission through Kairos' enrollment lottery.

Information provided will be kept private as part of your child's education records.

Kairos is authorized to enroll students entering grades 6-8.

Applications for other grades are considered "interest forms" that will be shared with our Kairos Board and our sponsor as evidence of parent demand. If the Kairos Board and our sponsor approve authorizing additional grades, parents who submitted applications for those grades will be contacted to confirm interest in applying.



Have questions about Kairos? Contact our Chief Community Officer (info below).

Meet: calendly.com/kairos-academies
Call: 314-607-0076
Email: cco@kairosacademies.org
First Adult: General Information
This section requests information about YOU, the student's parent, guardian, caretaker, or adult point-of-contact.
First Adult: First Name *
First Adult: Last Name *
First Adult: Phone Number *
First Adult: Cell Phone Carrier
This ensures that you'll get messages through our automated communication system.
First Adult: Email Address *
First Adult: Relationship to Student *
First Adult: Legal Custody? *
Do you have legal custody of the student? Are you authorized to enroll the student in a new school? (In the case of custody issues or court orders, please describe the terms in the "Other" line. Kairos will follow up for supporting documentation.)
First Adult: Annual Household Income?
The state and federal governments fund students at different levels depending on annual household income (e.g., reimbursements on free-and-reduced-priced lunches). To budget accordingly, we're requesting general census-style income information. Answers will not impact your registration at Kairos. To calculate the number of family members in your house, add: (i) yourself + (ii) your spouse/partner + (iii) the number of children (even if they don't live with you) who receive more than half of their support from you + (iv) the number of people (not children or spouse) who live with you and receive more than half of their support from you.
Family Members in House: 2
Family Members in House: 3
Family Members in House: 4
Family Members in House: 5
Family Members in House: 6
Family Members in House: 7
Family Members in House: 8
< $20,000 (less than $20,000)
$20,000-$30,000
$30,000-$40,000
$40,000-$50,000
$50,000-$60,000
$60,000-$70,000
> $80,000 (more than $80,000)
First Adult: Financial Assistance (Do you or your child currently receive...)
Like the previous question, this answer affects state funding and is required for budgeting purposes.
First Adult: Medical Assistance
Like the previous question, this answer affects state funding and is required for budgeting purposes.
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Second Adult: General Information
If there is no second parent, guardian, caretaker, or point of contact, please skip this section.
Second Adult: First Name
Second Adult: Last Name
Second Adult: Phone Number
Second Adult: Cell Phone Carrier
This ensures you'll get messages through our automated communication system.
Second Adult: Email Address
Second Adult: Relationship to Student
Second Adult: Legal Custody?
Does the second adult have legal custody of the student? (In the case of custody issues or court orders, please describe the terms in the "Other" line. Kairos will follow up for supporting documentation.)
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Student: General Information
Student: First Name *
Student: Last Name *
Student: Phone
If the student has a phone number, otherwise leave blank.
Student: Email
If the student has an email address, otherwise leave blank.
Student: Date of Birth *
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DD
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Student: Race
Student: Ethnicity
Student: Gender Pronoun
Student: Schooling Information
Student: Current School Name
Student: Current School City & State
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Student: Date Student Last Attended (approximate)
MM
/
DD
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YYYY
Student: Other Schools Attended in the Past 24 Months
Student: Current Grade Level (2019/2020 school year) *
Student: IEP or 504 Plan
Does your child have an IEP (i.e., diagnosed learning disability) or 504 Plan? Please indicate the with which your child has been diagnosed:
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Student: Disciplinary History
Has your child been expelled from another school for violations of school policies relating to weapons, drugs, or alcohol? (Answering falsely could result in your conviction of a class B misdemeanor.)
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Student: Record Release
To enroll at Kairos, you must authorize the students' previous school(s) to release student records to Kairos Academies. This is standard procedure, pursuant to state law, any time a student enters a new school. Kairos will request the following records from the students' previous school(s): health records, report cards, behavior/discipline reports (including Safe Schools Act violations), standardized test scores, 504 Plans, ELL plans, special education documentation (including evaluation reports and IEPs).
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Student: Housing Information
School District of Residence
In accordance with Missouri Revised Statute 160.410.1 (2), Nonresident pupils eligible to attend a Kairos Academies under an urban voluntary transfer program; students from the county districts must be non-African American.
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Student: Zip Code *
Example: "63118."
Student: Street Address *
Example: "2315 Miami St." (Pursuant to state law, Kairos must rescind enrollment if you cannot prove residency at the address provided. For ways to prove residency, please see www.tinyurl.com/KairosRegister.)
Student: Are you or the student currently...
Check all that apply. If none apply, please leave blank. If desired, use "Other" to add further explanation.
Student: Did you or the student move in the past 36 months to obtain agriculture or fishing work?
A move qualifies if all the following are true: (i) it is a move across school district boundaries; (ii) it involves a change of residence; (iii) the purpose of the move was to obtain work in agriculture or fishing; (iv) the purpose of the move was not to relocate on a permanent basis; and (v) it occurred within the preceding 36 months.
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Student: Did the student immigrate to the United States in the past three (3) years?
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Is your child's parent or legal guardian in the US Military?
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Student: Language Information
Student: What was the student's first language?
If not English, please write the language(s) in "Other."
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Student: Which language(s) does the student speak at home?
If not English, please write the language(s) in "Other."
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Student: Which language(s) does your child hear at home and understand?
If not English, please write the language(s) in "Other."
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Community Building
What is your student's t-shirt size?
We'll be handing out Kairos t-shirts to families who complete every step in the Kairos registration packet (www.tinyurl.com/KairosRegister) by Kairos Community Day. (Don't worry if you're a few days late—your child will get a t-shirt as soon as you do submit!)
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Would you like to join the Kairos Family Council (our PTA/PTO)?
If so, we'll follow up with more information in spring/summer.
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Do you know other families that we should contact about enrolling at Kairos?
Please put the names and contact information for parents of 3rd-5th graders who might want to learn more about Kairos (e.g., your student's classmates, friends, relatives). We'll reach out to them! If you don't know anybody, please leave blank.
Would you be willing to host a small gathering of parents interested in learning more about Kairos, either at your home or at Kairos' offices?
If so, we'll follow up with more information. Kairos will organize all logistics.
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