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Today's Date: ______________________________________________________________________
Student's Name: _____________________________________________________________________
Student's Birthdate and Year_____________________________________________________________
Address: ___________________________________________________________________________
__________________________________________________________________________________
Parent's names: ______________________________________________________________________
Email:_____________________________________________________________________________
Home Phone: ________________________________________________________________________
Work Phone: ________________________________________________________________________
Present school ________________________________________Present grade ('06-07) ______________
Sex: Female____ Male____
Race: Asian____ Hispanic____ African American _____ Indian _____ White_____ Other_____
Free or reduced lunch: Yes____ No____
Income: under $15,000____ $15,000 - $25,000____ $25,000 - $35, 000 ____ above $35,000 ____
Does your child currently have an IEP: Yes____ No____
Please list any other special needs or programs for your child that would help us in placement and planning_________________________________________________________________________________ _______________________________________________________________________________________
The Museum School is a public Charter School. Student attendance is absolutely critical to our operation. Please list any reasons why your child might not be able to attend school on a regular basis ________________________________________________________________________________________ ________________________________________________________________________________________
Please attatch a copy of your child's most recent progress report to help us in planning and determining the needs of your child's education program. (Student enrollment is based on space available via lottery [not grades], as per California law requires.)