Elementary school
Content
FOR OFFICE USE SCHOOL YEAR
Seminole County Public Schools ELEMENTARY MAGNET SCHOOL APPLICATION www.seminoleschoolchoices.com 407-320-0576 PART 1: STUDENT INFORMATION
Student Name Home Address
All information below must be completed. Please return to: Educational Support Center – Choices Department 400 East Lake Mary Boulevard—Sanford, FL 32773-7127 Fax: 407-320-0105
2013-14
Zoned Schools
PZ
ES ____________ MS ____________ HS ____________
|dddddddddddddddddddddddddddddddddddddd
Last First MI
Home Phone
ddd-|ddd-|dddd ddddd ddddd
|dddddddddddddddddddddddd
Street# Street Apt. # (If different from home address)
City |dddddddddddddd State |dd Zip Code
Mailing Address |dddddddddddddddddddddddd City |dddddddddddddd State |dd Zip Code Current School Gender
|dddddddddddddddd
Female AYP Choice Yes No
Current Grade Level
dd
Birth date
|dd-|dd-|dd
Yes No
Male
Are you a current resident of Seminole County? Yes No Does your child have a current IEP for Exceptional Education? Yes
No
Has your child ever attended a Seminole County Public School? Is your child currently in an ESOL program? Yes No
Applications are grade level specific. Students who are retained are required to reapply.
Penalties for Misrepresentation: I certify that all of the above information is true and correct. I understand that giving false information will invalidate this assignment. Florida Statue 837.06 provides that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his official duty shall be guilty of a misdemeanor of the second degree. • I agree that if selected, the student will remain in the program for a minimum of one year. • In all years of participation in a magnet school/program, midyear exits are not permitted unless the school determines the student does not meet academic and/or program requirements at the end of the semester. • I commit my support to the school and agree to participate in any parent/teacher conferences necessary to support my child’s success.
Parent Name |dddddddddddddddddddddddddddd Parent Signature ________________________________________________________________
(Application is incomplete without parent signature.)
Daytime Phone |ddd-|ddd-|dddd Date_____________________________________________
Email address (Optional) |dddddddddddddddddddddddddddd PART 3: ASSIGNMENT INFORMATION Please indicate a school choice by writing an “X” in the blank next to the desired school.
Goldsboro Elementary Magnet School
Math, Science, and Technology
Midway Elementary School
Fine Arts Magnet
Please check the student’s grade level for 2013-2014 below. K 1 2 3 4 5
SCPS Form 1202G 01/02/2013 WEB
Page 1 of 2
Seminole County Public Schools ELEMENTARY MAGNET SCHOOL APPLICATION
Student Name:_____________________________________________
PART 4: FAMILY INFORMATION Please check if older sibling(s) are currently enrolled at Goldsboro or Midway. List name(s) and grade level(s) of sibling(s) attending Goldsboro or Midway:
Name(s) Please Print Date of Birth Current Grade Level
______________________________________________________ ______________________________________________________ ______________________________________________________
__________________________ __________________________ __________________________
__________ __________ __________
Check one option: Current Grade Level
FAMILY GROUPS: A SEPARATE APPLICATION MUST BE SUBMITTED FOR EACH CHILD. Please list below any elementary age brothers/sisters (siblings) also applying for Goldsboro or Midway:
Name(s) Please Print
Date of Birth
Select students separately Select students as a family group only
______________________________________________________ ______________________________________________________ ______________________________________________________ PART 5: SOCIOECONOMIC INFORMATION
__________________________ __________________________ __________________________
__________ __________ __________
Has your family ever qualified for free or reduced price lunch?
Yes
No
Does your family qualify for free or reduced lunch price now?
Yes
No
School _____________________________ Year(s) ______________District _____________________________
Refer to the Income Eligibility Guidelines chart below.
List all students in your family that are currently enrolled in Seminole County Public Schools.
Student Name Date of Birth Grade Level
INCOME ELIGIBILITY GUIDELINES
Effective from July 1, 2012 to June 30, 2013 MAXIMUM INCOME HOUSEHOLD SIZE ANNUALLY 1 20,665 2 27,991 3 35,317 4 42,643 5 49,969 6 57,295 7 64,621 8 71,947 FOR EACH ADDITIONAL 7,326 FAMILY MEMBER, ADD MONTHLY WEEKLY
This chart is provided as a guideline only. To receive free/reduced lunch, families must complete and submit a Family Application for Free/Reduced Price Meals from the SCPS Food Services Department. Applications are available at all schools. Remember: The total income before taxes, social security, health benefits, union dues, or other deductions must be included.
1,723 2,333 2,944 3,554 4,165 4,775 5,386 5,996 611
398 539 680 821 961 1,102 1,243 1,384 141
SCPS Form 1202G 01/02/2013 WEB
Page 2 of 2
Seminole County Public Schools ELEMENTARY MAGNET SCHOOL APPLICATION www.seminoleschoolchoices.com 407-320-0576 PART 1: STUDENT INFORMATION
Student Name Home Address
All information below must be completed. Please return to: Educational Support Center – Choices Department 400 East Lake Mary Boulevard—Sanford, FL 32773-7127 Fax: 407-320-0105
2013-14
Zoned Schools
PZ
ES ____________ MS ____________ HS ____________
|dddddddddddddddddddddddddddddddddddddd
Last First MI
Home Phone
ddd-|ddd-|dddd ddddd ddddd
|dddddddddddddddddddddddd
Street# Street Apt. # (If different from home address)
City |dddddddddddddd State |dd Zip Code
Mailing Address |dddddddddddddddddddddddd City |dddddddddddddd State |dd Zip Code Current School Gender
|dddddddddddddddd
Female AYP Choice Yes No
Current Grade Level
dd
Birth date
|dd-|dd-|dd
Yes No
Male
Are you a current resident of Seminole County? Yes No Does your child have a current IEP for Exceptional Education? Yes
No
Has your child ever attended a Seminole County Public School? Is your child currently in an ESOL program? Yes No
Applications are grade level specific. Students who are retained are required to reapply.
Penalties for Misrepresentation: I certify that all of the above information is true and correct. I understand that giving false information will invalidate this assignment. Florida Statue 837.06 provides that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his official duty shall be guilty of a misdemeanor of the second degree. • I agree that if selected, the student will remain in the program for a minimum of one year. • In all years of participation in a magnet school/program, midyear exits are not permitted unless the school determines the student does not meet academic and/or program requirements at the end of the semester. • I commit my support to the school and agree to participate in any parent/teacher conferences necessary to support my child’s success.
Parent Name |dddddddddddddddddddddddddddd Parent Signature ________________________________________________________________
(Application is incomplete without parent signature.)
Daytime Phone |ddd-|ddd-|dddd Date_____________________________________________
Email address (Optional) |dddddddddddddddddddddddddddd PART 3: ASSIGNMENT INFORMATION Please indicate a school choice by writing an “X” in the blank next to the desired school.
Goldsboro Elementary Magnet School
Math, Science, and Technology
Midway Elementary School
Fine Arts Magnet
Please check the student’s grade level for 2013-2014 below. K 1 2 3 4 5
SCPS Form 1202G 01/02/2013 WEB
Page 1 of 2
Seminole County Public Schools ELEMENTARY MAGNET SCHOOL APPLICATION
Student Name:_____________________________________________
PART 4: FAMILY INFORMATION Please check if older sibling(s) are currently enrolled at Goldsboro or Midway. List name(s) and grade level(s) of sibling(s) attending Goldsboro or Midway:
Name(s) Please Print Date of Birth Current Grade Level
______________________________________________________ ______________________________________________________ ______________________________________________________
__________________________ __________________________ __________________________
__________ __________ __________
Check one option: Current Grade Level
FAMILY GROUPS: A SEPARATE APPLICATION MUST BE SUBMITTED FOR EACH CHILD. Please list below any elementary age brothers/sisters (siblings) also applying for Goldsboro or Midway:
Name(s) Please Print
Date of Birth
Select students separately Select students as a family group only
______________________________________________________ ______________________________________________________ ______________________________________________________ PART 5: SOCIOECONOMIC INFORMATION
__________________________ __________________________ __________________________
__________ __________ __________
Has your family ever qualified for free or reduced price lunch?
Yes
No
Does your family qualify for free or reduced lunch price now?
Yes
No
School _____________________________ Year(s) ______________District _____________________________
Refer to the Income Eligibility Guidelines chart below.
List all students in your family that are currently enrolled in Seminole County Public Schools.
Student Name Date of Birth Grade Level
INCOME ELIGIBILITY GUIDELINES
Effective from July 1, 2012 to June 30, 2013 MAXIMUM INCOME HOUSEHOLD SIZE ANNUALLY 1 20,665 2 27,991 3 35,317 4 42,643 5 49,969 6 57,295 7 64,621 8 71,947 FOR EACH ADDITIONAL 7,326 FAMILY MEMBER, ADD MONTHLY WEEKLY
This chart is provided as a guideline only. To receive free/reduced lunch, families must complete and submit a Family Application for Free/Reduced Price Meals from the SCPS Food Services Department. Applications are available at all schools. Remember: The total income before taxes, social security, health benefits, union dues, or other deductions must be included.
1,723 2,333 2,944 3,554 4,165 4,775 5,386 5,996 611
398 539 680 821 961 1,102 1,243 1,384 141
SCPS Form 1202G 01/02/2013 WEB
Page 2 of 2
