Student Enrollment Application

Cesar Chavez Academy &
Dolores Huerta Preparatory High

DISCLAMER!
I intend to enroll my child at Cesar Chavez Academy or Dolores Huerta Preparatory High.

By filling out this form, it does not obligate your child to attend.

PLEASE NOTE THAT IF YOUR ADDRESS OR PHONE NUMBER CHANGES, IT IS YOUR RESPONSIBILITY TO INFORM THE SCHOOL. YOUR CHILD MAY NOT BE ACCEPTED IF THIS INFORMATION IS NOT UP-TO-DATE.

 

ALL FIELDS ARE REQUIRED!

Child's last name *
Child's first name *
Child's middle name *
For what academic year are you applying: *	----2011-20122012-20132013-2014
Grade Level (for year you are applying for): *	----KG1st2nd3rd4th5th6th7th8th9th10th11th12th
Child's date of birth (dd/mm/yyyy) *
School to which you are applying: *	----Cesar Chavez AcademyDolores Huerta Preparatory High
Last school attended *
Home address *
City *
State *
Zip *
Home telephone (xxx-xxx-xxxx) *
Mother's telephone (xxx-xxx-xxxx) *
Father's telephone (xxx-xxx-xxxx) *
Emergency phone 1 (xxx-xxx-xxxx) *
Emergency phone 2 (xxx-xxx-xxxx) *
Mothers Last Name, First Name *
Fathers Last Name, First Name *
Email Address *
Do you currently have a sibling attending or that has already been accepted to CCA or DHPH? *	----yesno
If yes, Sibling Name *
Sibling Grade Level *
Does your child require special educational accomodations? *	----YesNo
Type: IEP, 504, etc. *
Any other accomodations? *
From whom or where did you hear about CCA or DHPH? *
In which Colorado county do you reside? *
Do you or your spouse work for the federal govt? *	----YesNo
Do you wish to participate in extra curricular activities? *	----YesNo
Please name the extra curricular activity in which your child wishes to participate: *
If your choice is music, please name instrument
Parents' military status *	----Neither parent is in militaryMother is in militaryFather is in militaryBoth parents are in military
Submitted by *
Submit date *