CLAYTON VALLEY CHARTER HIGH SCHOOL 2012‐2013 OPEN ENROLLMENT APPLICATION This form is ONLY for prospective students who do NOT live in the current CVHS attendance area. Please PRINT in INK and fill out completely. Completed applications should be submitted January 28th through March 7th, 2012 to CLAYTON VALLEY HIGH SCHOOL Front Office or via fax to 925‐825‐7859. A confirmation number will be issued upon receipt of completed application. For more information, please visit our website at www.claytonvalley.org. Upon lottery acceptance, enrollment is not complete until a full registration packet is submitted.
STUDENT’S NAME: Last
First
Middle
STUDENT’S ADDRESS: Number and Street
STUDENT’S DATE OF BIRTH: Month
Day
STUDENT’S GENDER:
City
Male
Year
Female
SCHOOL STUDENT IS NOW ATTENDING:
DISTRICT RESIDENT? Yes?
STUDENT’S GRADE (2012‐2013 School Year):
No?
Does / Did student have siblings attending Clayton Valley Charter High School? Name of Sibling:
State and Zip Code
Yes
No
Current Grade (or Year of Graduation):
PARENT OR GUARDIAN’S NAME: Last
First
Middle
PARENT OR GUARDIAN’S ADDRESS: Number and Street
( ) Home Phone #
City
( ) Work Phone #
State and Zip Code
( ) Cell Phone #
@
Email Address: NOTES:
• Under current North Coast Section California Interscholastic Federation (CIF) rules, participation in athletics may be restricted for junior or senior students. • Parents or guardians should plan to provide their own transportation to and from school for all students • Failure to report requested information may lead to dismissal of your child from the school. Signature of Parent or Guardian:
Date:
Processing of the application is dependent upon accurate and complete information.
FOR OFFICE USE ONLY DATE RECEIVED:
APPLICATION #:
LOTTERY PLACEMENT #