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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 BoulevardSanford, FL 32773-7127 Fax: 407-320-0105
2013-14
Zoned Schools
PZ
|dddddddddddddddddddddddddddddddddddddd
Last First MI
Home Phone
|dddddddddddddddddddddddd
Street# Street Apt. # (If different from home address)
Mailing Address |dddddddddddddddddddddddd City |dddddddddddddd State |dd Zip Code Current School Gender
|dddddddddddddddd
Female AYP Choice Yes No
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 childs success.
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.
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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
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
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
List all students in your family that are currently enrolled in Seminole County Public Schools.
Student Name Date of Birth Grade Level
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.
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