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Student Name

Date

Birth Date

Age

Current Grade

Gender

Male

Female

Other

Sibling Names and Ages

Number

Parent/Guardian's Name

Phone

Address

School District of Residence:

Does your child have a current IEP?

Yes

Does your child have a diagnosis?

Yes

Please state their official diagnosis:

Parent/Guardian Signature

Once the initial application is submitted, Spectrum Charter School will call you to schedule a date & time to visit the school. Thank you.

*Spectrum Charter School does not discriminate based on race, creed, color, gender, national origin, religion, or disability.