Title One/Adequate Yearly Progress Choice



Magnet/Choice School Application 2020/2021

INSTRUCTIONS:

1. Complete one application for each child.

2. Print legible numbers and capital block letters in the boxes.

3. To be valid, each application must be complete, signed and dated by a parent or guardian.

Incomplete applications will not be processed.

4. If you are completing applications for more than one of your children, mail the applications together.

There is no guarantee that all siblings will be able to attend the magnet/choice school.

5. Incomplete applications will be returned and will affect your waiting list number.

IMPORTANT INFORMATION:

1. You may only apply for the magnet/choice schools in your zoned area. Students that move from one zone to another must reapply for the magnet/choice school in their area.

2. All applications must be postmarked and include a return address to determine priority on waiting lists. No hand deliveries or school based courier mail will be accepted. You must use U.S. Mail to send completed applications.

3. If you are on the waiting list in good standing, please do not reapply.

4. Enrollments are set by grade level, racial balance of the sending school and receiving school, and physical space.

5. Students that are retained must reapply in order to be eligible.

6. ESE classes (other than Alpha) may be limited.

7. It is your responsibility to advise the Office of School Choice if you have a change of address and/or phone number.

8. If you accept enrollment to a magnet/choice school, your child will be taken off all other magnet/choice waiting lists.

STUDENT INFORMATION:

Student ID Number

5300

Student’s Legal Name – Last Name

First Name Full Middle Name

Home Address – Street Address

City State ZIP Code

Ethnic Code – Choose

only one from the list

below and write the number

Mailing Address – Street Address in this box.

City State ZIP Code

Social Security Number Home Telephone Number Date of Birth–Month-Day-Year

FAMILY INFORMATION:

Parent/Guardian living in the same household as the student.

Last Name First Name

Home Telephone Number Work Telephone Number

Please list any sibling(s) (brother, sister, half, or step) in the same household currently enrolled/applying at this Magnet/Choice School(s).

Last Name First Name

| | | | | | | | |

[pic] Enrolled [pic] Applying/Waiting List

M M - D D - Y Y Y Y

Last Name First Name

| | | | | | | | |

[pic] Enrolled [pic] Applying/Waiting List

M M - D D - Y Y Y Y

Last Name First Name

| | | | | | | | |

[pic] Enrolled [pic] Applying/Waiting List

M M - D D - Y Y Y Y

Please mark the bubble next to the school(s) for which you wish to apply. (DO NOT do not write in additional schools. The schools listed are your only choices) (Your child must eligible to attend elementary school NEXT year.)

[pic] Dundee Elementary Academy (serves grades K-4)

I have read the parent contract and Magnet/Choice School information for each of the schools for which I am applying. (Parent contracts and guidelines are available with applications.)

Date Signature of Parent/Guardian

| | | | | | | | |

M M - D D - Y Y Y Y[pic]

-----------------------

Mail to: Office of School Choice

P.O. Box 391

Bartow, FL 33831

(Incoming Kindergarten students and students new to Polk County schools may leave this blank.)

Gender Employee Child

[pic] Male [pic]Female [pic] Yes [pic] No

Possible Retention Twin, etc.

[pic] Yes [pic] No [pic] Yes [pic] No

Current Grade Level

Examples: Preschool=00

Kindergarten=KG

First Grade=01

1 Multiracial-Black

2 African American

3 White

4 Hispanic

5 Indian

6 Asian

7 Multiracial

Non-Black

HC

PRIORITIES:

1

2

3

ELEMENTARY MAGNET/CHOICE SCHOOL SELECTIONS:

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