INITIAL

STUDENT DATA REGISTRATION FORM

(Please carefully read Instructions on pages 23 before completing.) GENERAL INFORMATION
School for Which Student is Registering (Name and City)

STUDENT INFORMATION
Students Legal Name (Last, First, Middle) Students DOB (MM/DD/YYYY) Students Primary Residence (Street Name, Building and/or Apt. #, City, State, ZIP) Students Primary Phone (Check One: Home Grade Entering for the 20122013 School Year Work Cell) School Student Attended During the 20112012 School Year (School Name, City, State) Does the student have a sibling who is currently enrolled at one of Responsive Education Solutions family of schools (e.g., Vista Academy, Quest Middle School, iSchool High, Premier High School, Texas Virtual Academy, etc.)? Yes No If Yes, please list the name and campus of each enrolled sibling. Does the student have a documented history of a criminal offense, a juvenile court adjudication, or disciplinary problems? Yes No If Yes, please explain.

PARENT/GUARDIAN INFORMATION
Parent/Guardian with Whom the Student Lives DOB (MM/DD/YYYY) Relationship to Student DOB (MM/DD/YYYY)

Fathers/Guardians Name (Last, First, Middle) Fathers/Guardians Primary Residence (If Different From Students Address) Fathers/Guardians Primary Phone (Check One: Home Work Cell) Mothers/Guardians Name (Last, First, Middle) Mothers/Guardians Primary Residence (If Different From Students Address)

Fathers/Guardians Email DOB (MM/DD/YYYY)

Mothers/Guardians Primary Phone (Check One: Home

Work

Cell)

Mothers/Guardians Email

INITIAL STUDENT DATA REGISTRATION FORM

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SIGNATURE
Parent/Guardian Signature: I certify that the information contained in this Form is true and correct. Date

SCHOOL USE ONLY

Date and Time of Receipt

INSTRUCTIONS
General Information: The Initial Student Data Registration Form (Form) should be completed by the students parent/guardian. Please print all answers legibly. If a field does not apply, please write N/A. Failure to provide information on this Form sufficient to permit the school to offer provisional admission to the student based on qualifying residency and disciplinary history will require a conference with the Campus Director or designee to obtain additional information. Provisional Admission: All eligible applicantsi.e., students with qualifying residency and disciplinary historywill be notified of provisional admission pending the close of the openenrollment period and the determination of the need for a lottery. Lottery: If the number of eligible applicants does not exceed the number of vacancies, then all eligible applicants who have timely applied during the openenrollment period will be offered admission. If there are more eligible applicants than available spaces in a class/grade/school, then a lottery will be conducted at a time set by the school each year. A name (or number assigned to a name) will be drawn for each vacancy that exists, and each applicant whose name (or number) is drawn will be offered admission. The remaining names will then be drawn and placed on a waiting list in the order in which they were drawn. Notification of admission will be made by telephone, email, or U.S. Postal Service. Failure of a parent/guardian to respond within 48 hours of the date of the telephone call or email, or within three business days of a postmarked letter, will forfeit his or her position in the lottery. Parents/Guardians should call the school immediately upon receipt of the notice in order to preserve their students position in the lottery. If a vacancy arises before the commencement of the school year, the individual on the waiting list with the lowest number assignment will be offered admission and then removed from the waiting list. If an application is received after the openenrollment period has passed, the applicants name will be added to the waiting list behind the names of the eligible applicants who timely applied. Exceptions: Federal guidelines permit the school to exempt from the lottery process students who are already admitted, siblings of students already admitted, children of the charters founders, and children of the schools employees. Enrollment: Students offered admission to the school will be required to complete the schools enrollment packet to complete the enrollment process. Residency Information: To be eligible for continued enrollment in the school, the parent/guardian must show proof of residency at the time of enrollment. Failure to comply with this requirement will result in the immediate initiation of procedures to exclude the student from enrollment.

INITIAL STUDENT DATA REGISTRATION FORM

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 Disciplinary History: If it is later discovered that the parent/guardian failed to disclose the documented history of a disqualifying criminal offense, a juvenile court adjudication, or disciplinary problems, the school will immediately initiate procedures to exclude the student from enrollment. Parental Rights: The completion of this Form does not determine the parental relationship and does not affect legal right of access to the student or the students records. Providing False Information: A person who knowingly falsifies information on this Form may be guilty of an offense under Section 37.10 of the Texas Penal Code. NonDiscrimination: In accordance with the Texas Education Code and the schools charter, it is the policy of the school to prohibit discrimination in student admission on the basis of sex, national origin, ethnicity, religion, disability, academic, artistic, athletic ability, or the district the student would otherwise attend.

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