Student Name (please print)
Parent Name (please print)
Parents: Circle the letter that reflects your student’s status. Under the appropriate category initial in
each space to verify that you have submitted the appropriate information as required. This cover sheet
is to be attached to the application and accompanying documentation.
A. The student was enrolled in a Greenville County school this year:
Name of Greenville County school student attended
B. The student is not currently enrolled in a Greenville County school (this includes students
who attended private or charter schools and home-schooled students):
Name of school attended
Parents are responsible for submitting all required documentation by the open enrollment deadline.
If you need additional information, please contact admission office at 864-248-0646. Fax number
is 864-631-1109.
Each student should complete a basic application form signed by the parent or guardian. Applications
are accepted at the main office of Legacy Middle (Grades 5-8) and Legacy Early College High School
(Grades 9-12) during normal business hours or may be mailed to:
Legacy Middle Charter School or Legacy Early College High School, 900 Woodside Avenue,
Greenville, SC 29611
Please provide the following documentation with the application for administrative review.
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Current or most recent grades
PowerSchool Attendance Report
Discipline Report
Transcript
If applicable: Copy of IEP ___ 504 ___ Gifted and Talented ____ Standardized Test Score _____
o Please provide a copy of IEP, 504, Gifted and Talented Form, and Standardized Test Scores
Proof of Address (Residence in Greenville County required.)
Equal Education Opportunity: No student shall be denied equal opportunity for admission on the basis
of race, sex, color, religion, handicap, marital status or national origin.
Legacy Charter School is open to all students in grades K5-12 for the 2015-2016 school year.
*Note: Incomplete application will not be processed.
Parent Signature:
Student Signature:
Date Application Submitted to School:
Please be reminded that any false documentation placed on this application will lead to dismissal of your child from Legacy
Charter School
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(For office use only)
Received Date_____________
Interview Date___________
Interviewed By_________
Application Complete:
___________________
_____Birth Certificate
_____Immunization Records
_____Social Security Card
_____Proof of Address
Please clearly PRINT all information
STUDENT NAME: (as it appears on birth certificate and report card)
First:
Middle:
Date of Birth (Month/Day/Year):
____
Last:
Male ______ Female ______
Grade level applying for:
Street Address:
City & State
Zip:
PARENT/LEGAL GUARDIAN INFORMATION
First Name:
Middle:
Home Phone:
Last:
Work Phone:
Cell Phone:______________________
E-mail:
Street Address if different from above:
City & State:
Zip:
I am a resident of Greenville County Yes
No _______
Primary Home Language _______________________________
STUDENT INFORMATION
Schools(s) Attended for previous two years:
Ethnicity:
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Asian (Latino)
White
Black or African American
Gender:
F
M
Is student currently receiving Special Education Services/ 504/ Speech/ PT/OT or Mental Health?
Yes______ No_______ Does your student have an IEP? Yes______ No_______
Have you ever had an attendance court order? Yes_______ No _______
Is student currently receiving ESOL Services? Yes
Does student have any behavioral needs? Yes
No
No
Do you have a sibling who is currently attending LCS? Yes ________ No ______
If yes, what is your sibling’s name? ____________________________________ Grade ___________
Date of Application ________________________
Received by ____________________
Please be reminded that any false documentation placed on this application will lead to dismissal of your child from Legacy
Charter School
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