TOLEDO SCHOOL FOR THE ARTS

Enrollment Application
INSTRUCTIONS: PLEASE PRINT ALL INFORMATION ACCURATELY AND COMPLETE IN BLUE OR BLACK INK.

Legal Name: DOB:

Last Name First Name Middle Name

City of Birth: County of Birth: State of Birth:

Current Address: City: Zip:

SSN: Home Phone: Alt Phone:

Name of Parent/Guardian(s):

Is there a legal custodial agreement? Y N N/A (If YES, attach a copy)

Grade Applying For: (CIRCLE ONE) 06 07 08 09 10 11 12

Specific Area of Interest:

Specific Educational or Medical Needs:

Have you ever had an IEP, MFE, or 504 Plan? Y N If YES, please explain

Do you have an Active IEP or MFE? Y N (If YES, attach a copy) Date of IEP: Date of MFE:

Current School: Current Grade:

Any prior suspensions? Y N If YES, how many? Dates:

Any prior expulsions? Y N If YES, why? Dates:

Have you failed a grade? Y N If YES, which grade and where?

Attendance last school year: Absences Tardies Verified by

How did you hear about TSA?

If it was word of mouth by a current or former student, please give student name:

Note: Completion of this form and submission to the Toledo School for the Arts will not constitute guaranteed acceptance to the school. TSA
accepts 80 students per grade level. Acceptance to TSA requires participation in a placement interview, scheduled on a first come-first serve
basis. After 80 students are enrolled, the remaining student names will be submitted for a lottery. The lottery determines the waiting list number.
Students will be called to interview if those accepted students withdraw for any reason. A new application will must be completed each school
year. Any student applying for the wrong grade level will be denied admission. The Toledo School for the Arts is a community school
established under Chapter 3314 of the Ohio Revised Code. TSA is a public school and its students are required to pass proficiency tests and other
examinations prescribed by law. Students who have been excused from the compulsory attendance law for home instruction as defined by the
Administrative Code shall no longer be excused for that purpose upon their enrollment at TSA. For further information regarding the above
issues, contact the school administration or the Ohio Department of Education.

By signing below, you understand the aforementioned conditions of the application process and you attest to the honesty of the information
above. If any of the information on this application is found to be false, or intended to mislead, the student will no longer be eligible for
enrollment. Students entering from Home Instruction must provide a complete portfolio of work along with proper documentation from their
home school district. Please bring or mail this form (along with necessary documentation) to Toledo School for the Arts, ATTN:
Enrollment, 333 – 14th Street, Toledo, OH 43604.

Parent Signature: Date:

12/09 Version
 Enrollment Checklist
*required documentation to enroll at Toledo School for the Arts

Please return completed packet along with

___ TSA Application Form

___ Immunization Records
___ Unofficial Transcript (High School ONLY)
___ Current Grade Report (gr. 6-12)
___ Proof of Residency (utility bill; i.e., gas bill, water bill, etc.)
___ Copy of Birth Certificate & Social Security Card
___ ALL Standardized Test Scores
___ Copy of IEP and MFE, if applicable
___ Custodial Papers, if applicable
___ Homeschool Portfolio, if applicable (please request guidelines)

Interviews are scheduled based upon COMPLETED student information…please return

the application with the above information as quickly as possible.

12/09 Version