Student Enrollment Application for Grade 9
2010-2011 School Year

** indicates required field


STUDENT INFORMATION:

**First Name:

**Middle Name:

**Legal Last Name:

**Gender: Select Gender: Female Male

**Date of Birth: / / (mm/dd/yyyy)

** Social Security Number: xxx - xx - (Last 4 digits only)

**Home Address:

**City: **State: **Zip:

**Email Address:



SCHOOL INFORMATION:

**Neighborhood High School:

**Current School Name:

**Type of School: Select School Type: Public Private Charter Catholic Other

**Current Grade:

**Grade Applying: Select Grade Applying: 9

**Current School Address:

**Current School City: **State: **Zip:

**Current School Phone Number: - - (xxx-xxx-xxxx)



PARENT/LEGAL GUARDIAN INFORMATION:

**With whom does the applicant currently live: Select One: Mother Father Both Parents Guardian(s) Foster Parent(s) Other Relative(s)

If lives with legal guardian(s), explain relationship to child:


**Parent/Guardian 1: Mother Father Guardian

**Parent/Guardian 1 Last Name: First Name:

**Parent/Guardian 1 Street Address:

**Parent/Guardian 1 City: **State: **Zip:

**Parent/Guardian 1 Phone: - - (xxx-xxx-xxxx)

Parent/Guardian 1 Alt Phone: - - (xxx-xxx-xxxx)

Parent/Guardian 1 Alt Phone: - - (xxx-xxx-xxxx)

**Parent/Guardian 1 Email (the address you check most regularly):

Parent/Guardian 1 Alt Email:


Parent/Guardian 2: Mother Father Guardian

Parent/Guardian 2 Last Name: First Name:

Parent/Guardian 2 Street Address:

Parent/Guardian 2 City: State: Zip:

Parent/Guardian 2 Phone: - - (xxx-xxx-xxxx)

Parent/Guardian 2 Alt Phone: - - (xxx-xxx-xxxx)

Parent/Guardian 2 Alt Phone: - - (xxx-xxx-xxxx)

Parent/Guardian 2 Email (the address you check most regularly):

Parent/Guardian 2 Alt Email:

Email addresses are for school communications and will not be used for any other purposes. You must have an email address to receive ongoing communication from Tacony Academy Charter School.



SHORT ANSWER / ESSAY QUESTIONS:

Please answer the following questions explaining why you would like to attend Tacony Academy Charter School.

** Being a successful student at Tacony Academy will require hard work and dedication. Please describe what motivates you to learn and why you are interested in enrolling at Tacony Academy.


** Describe a time you worked with a group to complete a project. Or give an example when you were involved in cooperative decision-making in order to solve a problem.
(Please give 2 examples)



** Have you ever been suspended or expelled for violation of any School District of Philadelphia’s Drug/Alcohol Policy or Weapons Policy?
Y N

If yes, when? Were there conditions to your re-enrollment?
Please explain why you feel Tacony Academy Charter is a good option for your education?




INTEREST LETTERS (Student and Parent / Guardian):

** Student Letter of Interest must be typed in the area below.




PARENT / GUARDIAN SECTION:

Please answer the questions below and provide a letter of support for your child attending Tacony Academy Charter School. (Parents/Guardian may choose to write a letter of support jointly or with separate letters.)

** Why are you committed to the Tacony Academy Charter educational program?


** How can/will you support your child’s educational experience at Tacony Academy Charter?


** Parent Letter of Interest may be typed in the area below.




TACONY ACADEMY CHARTER HIGH SCHOOL STUDENT CONDUCT:

Please CLICK HERE to review the Code of Conduct.
Adults will make every reasonable attempt to work with students who exhibit behavior problems or disruptive behaviors. However, if behavioral problems persist, or if a student has a discipline problem severe enough to warrant a referral to the office, the staff will make contact with a parent/guardian to inform them of the disciplinary problems and request that actions be taken to correct the situation. All disciplinary consequences will be in accordance with Tacony Academy Charter School’s Board of Trustees approved policies.



DRESS CODE:

Please CLICK HERE to review the Student Dress Code Policy.
Business dress is the term used for attire worn at Tacony Academy Charter. All students are required to wear the Board of Trustees approved student uniform. Students will have many opportunities to present themselves to the business and professional community so each should be dressed as if they were going to work or introducing themselves for a job interview. There will be opportunities for students to dress differently or more casual, depending on the particular environment in which they are participating. However, on a daily basis, students should look appropriate for business environment.



ACADEMIC INTEGRITY STATEMENT:

Please CLICK HERE to review the Academic Integrity Policy.
Tacony Academy Charter Prep School ( Tacony Prep) is a place where learning and academic achievement are based on the character traits of respect, excellence, accountability, consideration, and honesty. Our students are held to the highest standards of performance and integrity. We expect Tacony Prep students to take responsibility for their actions and as a result, maintain academic honesty and a positive learning environment for all students.

• I understand that cheating, falsifying, assisting with dishonest acts, or plagiarizing on exams, tests, quizzes, assignments, projects, or any other schoolwork violates Tacony Prep’s Academic Integrity Policy.

• I understand that helping another student violate Tacony Prep’s academic integrity standards by sharing my schoolwork with another student without specific teacher permission is a violation of the Tacony Prep’s Academic Integrity Policy.

• I understand that I am accountable for my actions and I will accept responsibility and consequences for my actions.

• I have read the Tacony Academy Charter Prep’s Academic Integrity Policy on the website at www.taconyacademy.org



ACKNOWLEDGEMENT OF PHILOSOPHY:

Please CLICK HERE to review the Tacony Academy Charter School Philosophy.
It is our intent that all Tacony Academy Charter students and parents/guardians understand the nature of education offered is an option to the School District of Philadelphia’s high schools. It is in this spirit that we ask parents/guardians and students to read and discuss the philosophy, the Code of Conduct, and the Dress Code.

I further understand that if, during my tenure at Tacony Academy, I violate these standards, I may lose the opportunity to continue my education at Tacony Academy Charter.

I have an understanding of Tacony Academy Charter’s philosophy and believe that Tacony Academy will be the best educational setting for me. (A written signature will be required if this form is accepted.)


** I Agree: Student Name: Date: 09/07/2010
** I Agree: Parent/Guardian Name: Date: 09/07/2010



TACONY ACADEMY CHARTER SCHOOL STUDENT CONTRACT:

**I have read and am willing to follow the Tacony Academy Charter School Student Contract which includes expectations for conduct and appearance (dress code):

**Student Name: Date: 09/07/2010
**Grade Entering:

By clicking "I Agree" below, I certify that all the information provided in this application is accurate. I understand that if no space is currently available for placement of the applicant, this application will be held for inclusion in the next lottery process for the program/school requested. I have been given a copy of the Open Enrollment-Lottery Procedure and a description of the program for which this application is being submitted. I realize, too, that this application does not guarantee admission to the school and that the lottery procedure will place the applicant’s name on a wait list for the school. Any false statement is cause for nullification of this application. (A written signature will be required if this form is accepted.)

** I Agree: Student Name: Date: 09/07/2010
** I Agree: Parent/Guardian Name: Date: 09/07/2010