Oakland Opportunity Academy
Enrollment Request
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When complete, save as a .PDF using the student’s name
Student Name:
Date:
School District: Clarenceville School District
High School: Clarenceville High School
Student’s Phone #:
Student’s Email:
Sending District Grade Level:
Expected Year of Graduation:
Counselor:
Counselor’s Phone #:
Counselor’s Email:
UIC #:
Career Cluster Preference
Please indicate student’s choice for career clusters. Final enrollment is based on availability.
BMMT
Culinary
Transportation
Visual Imaging
Reason for Referral (Please check all that apply)
Credit deficit
Attendance
Teen parent
Smaller setting desired
Personal
Discipline
Adjudicated
Other
Additional Student Information
Has this student taken the MME? (All 3 days)
Yes
No (If yes, paperwork is attached)
Has this student ever received an IEP or 504 Plan?
Yes
No (If yes, paperwork is attached)
Does this student have a Personal Curriculum?
Yes
No (If yes, paperwork is attached)
Does this student qualify for Free/Reduced Lunch?
Yes
No (If yes, paperwork is attached)
Does the student have a medical plan?
Yes
No
Is English the primary language in the home?
Yes
No
If no, is the student being served by ELL/what Language?
Enrollment Process Checklist
Please be sure you have provided the following information for your student.
Behavior Discipline Summary
NA
Health/Emergency Form
NA
Cluster Request
IEP / 504
EDP
Reason(s) for Referral
Enrollment Request Form
Additional Student Information
Medical Plan
NA
NA