LANE TECH COLLEGE PREP HIGH SCHOOL 2012-2013 LTAC 8th grade Enrollment Form

Please PRINT ALL responses in INK. DATE_______________________ NAME: _________________________

Students Last Name Current Grade in School: Do you attend a Chicago Public School? Yes No If No, have you ever attended a Chicago Public School? Yes No

__________________________
Students First Name

_______
Students MI

Current Elementary School: ______________________________________________________________ Current Elementary School Address: ______________________________________________________ Current Elementary School Phone Number: ________________________________________________ CPS ID Number: __ __ __ __ __ __ __ __
(This is written on students CPS report card.)

Social Security Number: __ __ __ -__ __ -__ __ __ __

(Only needed if non-CPS student.)

Birth Date: ___________________ Sex (circle one): M

Number

Place of Birth: __________________________ Birth Certificate Number: _____________________________________ _____

Direction

Home Address: __________

_______________________
Street

_________
Apt #

City, State, Zip Code: ________________

_________

_____________ Relationship: __________________

(All students must have a valid Chicago residence by July 1, 2012, to be enrolled in a Chicago Public School.)

Name of Parent/Legal Guardian: ____________________________ Name of Father: _________________________________ Fathers email__________________________________ Fathers Cell Phone: __ __ __ - __ __ __ - __ __ __ __ Home Telephone: __ __ __ - __ __ __ - __ __ __ __ Emergency Information:

Mothers Maiden Name: Mothers email Mothers Cell Phone: __ __ __ - __ __ __ - __ __ __ __

Name: __________________________________ Relationship: ___________________

Emergency Telephone Number: __ __ __ - __ __ __ - __ __ __ __

LTAC CURRICULUM CHOICES

1. Students must choose one of the following world languages. Please circle your selection below.
French German Italian Latin Mandarin Spanish

2. Students must choose one of the following electives. Please mark an X next to your elective choice. Art Appreciation Band (complete Music Placement Form) Chorus/Vocal Computer Science/Programming Orchestra (complete Music Placement Form)
Any questions please contact Kathryn Beck, Academic Center Coordinator, 773-534-5649 or kebeck@cps.edu. Class descriptions may also be viewed at our website - www.lanetech.org/ltac.

This enrollment form must be returned to the Lane Tech Academic Center Office at Lane Tech by April 13, 2012.

Lane Tech Academic Center Class and Music Placement Form 2012-2013 Please complete this form ONLY if any of the following apply to you:
*You are currently enrolled in or have completed classes in 6th or 7th grade, which allow you to receive High School Credit. *You are planning to take Band or Orchestra as an 8th grader. *Please attach a copy of your current transcript with pending high school credits.

Please Print Name: Last First email__________________

CPS Student ID Number__ __ __ __ __ __ __ __ Home Phone:_________________ Elementary School: ______________________ Elem. School Code: __ __ __ __

HIGH SCHOOL CREDIT COURSES

Please list any credit bearing high school course(s) you have taken or are currently taking. Course Name School where taken ________________________ __________________________ ________________________ ________________________ ________________________ ________________________ ________________________ __________________________ __________________________ __________________________ __________________________ __________________________

Students who have taken or are currently taking an approved Middle School Algebra class for High School credit must pass the class with a C or higher and pass the Algebra exit exam. Students must provide a copy of the Algebra exit exam results (when available in May/June) to receive high school credit and to be enrolled in Geometry or Advanced Algebra.

MUSIC PLACEMENT
(Complete only if Elective Replacement was chosen) Please list any instrument(s) that you currently play and answer the related questions. If you signed up for band or orchestra and you do not return this form, it will be assumed that you do not know how to play an instrument and you will automatically be programmed for a beginning class. If you have any questions, please call the music department @ 773.534.5400. You may also address email to the music department by using www.lanetech.org. Please specify your grade level in the email. I can play the following instrument(s): Number of years played:__________________ Private Lessons? (circle one) YES NO

Parent/Guardian Signature (required): _________________________________________