Faith Family Kids, Inc.
dba
FAITH FAMILY ACADEMY
300 West Kiest Blvd., Dallas Texas 75224 - ph. 214-375-7682 – fax 214 –375-7681
701 Ovilla Road, Waxahachie, Texas 75167 – ph. 972-937-3704 – fax 972-937-5806
Application for Admission (Elementary/Middle/High School)
PLEASE ANSWER ALL QUESTIONS BELOW AND SIGN AT THE BOTTOM
Student’s Last Name
Date of Birth
First Name
Age as of Sept 1, 2015
Grade
Middle Name
Generation (Jr. I, II, III)
Social Security #
Other Phone #’s
Home Phone
With whom does child reside?
Street Address
City
Mailing Address (If different)
State
Father’s Name
Place of Employment
Zip
City
State
Zip
Mother’s name
Business Phone
Place of Employment
Business Phone
1. If your child has documented history, in reference to TEC Chapter 37, Subchapter A, has your child ever been expelled, dismissed, suspended
or refused admission to another public, private or charter school? Yes__ No__ Explain: ____________________________________________
2. If your child has documented history, in reference to TEC Chapter 37, Subchapter A, has child ever been assigned to an alternative program?
Yes____ or No ____ Explain: __________________________________________________________________
3. Does your child have any documented history of a Criminal offense?
Explain: __________________________________________________________________
4. If your child has documented history of a criminal offense has your child ever had disciplinary difficulties as defined by TEC Chapter 37, Subchapter A?
Yes____ or No ____
Explain: __________________________________________________________________
5. Has your child ever applied or been enrolled in Faith Family Academy? Yes ________ No_______
If so, when? ______________________________________________________________________
By my signature, I certify that the foregoing information is correct.
__________________________________________________________Date_____________
Parent or Guardian Signature
Disclosure Statements:
It is the policy of Faith Family Academy Charter School to comply with non-discrimination provisions of all federal and state laws. FFA admits students without regard to race, religion, color,
gender, age, national origin, ethnicity, disability, academic, artistic, athletic ability, marital status, political belief, limited English proficiency or the district the child would otherwise attend.
FFA will deny admission to students with documented histories of a criminal offense, juvenile court adjudication, or discipline problems under TEC Chapter 37, Subchapter A. If anyone
believes that they have been discriminated against, they should write to the Secretary of Education, Washington D.C. 20250.
Child Find - a free appropriate public education (FAPE) is provided to all individuals with disabilities, ages 4-21, who qualify for special education services. With the assistance of the Texas
Education Agency, ESCs, and the Early Childhood Intervention (ECI) program, LEAs must ensure that early intervention services are made available for those children, ages 0-3, with an
identified need.
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Faith Family Kids, Inc.
dba
FAITH FAMILY ACADEMY
300 West Kiest Blvd. -- Dallas Texas 75224 – ph. 214-375-7682 – fax 214-375-7681
701 Ovilla Road, Waxahachie, Texas 75167 – ph. 972-937-3704 – fax 972-937-5806
2015-2016 INFORMATION / CHECK LIST-WORKSHEET
Complete
REQUIREMENTS * ALL STUDENTS
Student Enrollment Application – COMPLETED IN FULL
Parent Agreement – Enrollment Information – Medical Form
Pick up List – Home Language Survey – Telecomputing Network Use Agreement – etc.
Certified Birth Certificate – not hospital issued (bring original to be copied and returned)
Complete Shot Records (bring original to be copied and returned)
Social Security Card (bring original to be copied and returned)
Most recent Report Card/Transcript
Withdrawal Form from school if student is transferring during school semesters
“YEAR END” report card for previous year (2014-2015)/ Summer School if applicable
Copy of IEP if student is in Special Education
Utility Bill showing current address of residence
If your child drives to school, a copy of current insurance, driver’s license, license plate, make, model and color of vehicle will be
required to be on file with FFA campus security
Meal Program Application must be completed returned and processed (one for each family). This is not available until the 1 st
day the child attends school with the exception of Pre-K
If you are not the birth parent(s), you must provide documents showing you have custody
INFORMATION FOR PARENTS
Student’s School Supplies (must bring the 1st day attending)
Uniforms MUST be worn from the 1st day attending school
All Pre-K-12 students are required to comply to State attendance laws
Pre-K students must qualify for state & Fed funded programs (income, language, other) ASK FOR FORM
All children must be completely toilet trained!
Pre-K must have turned age 4 by September 1 of school year
Kindergarten must have turned age 5 by September 1 of school year
Disclosure Statements:
It is the policy of Faith Family Academy Charter School to comply with non-discrimination provisions of all federal and state laws. FFA admits students without regard to race, religion, color,
gender, age, national origin, ethnicity, disability, academic, artistic, athletic ability, marital status, political belief, limited English proficiency or the district the child would otherwise attend.
FFA will deny admission to students with documented histories of a criminal offense, juvenile court adjudication, or discipline problems under TEC Chapter 37, Subchapter A. If anyone
believes that they have been discriminated against, they should write to the Secretary of Education, Washington D.C. 20250.
Child Find - a free appropriate public education (FAPE) is provided to all individuals with disabilities, ages 4-21, who qualify for special education services. With the assistance of the Texas
Education Agency, ESCs, and the Early Childhood Intervention (ECI) program, LEAs must ensure that early intervention services are made available for those children, ages 0-3, with an
identified need.
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Faith Family Kids, Inc.
dba
FAITH FAMILY ACADEMY
300 West Kiest Blvd., Dallas, Texas 75224 – ph. 214-375-7682 – fax 214-375-7681
701 Ovilla Road, Waxahachie, Texas 75167 – ph. 972-937-3704 – fax 972-937-5806
ENROLLMENT STUDENT PERSONAL INFORMATION
School year: ____________Date:___________
Last Name (As on Birth Certificate.)
Social Sec. No.
First Name (As on Birth Certificate)
Gender(male-female)
Middle Name (As on Birth Certificate)
Home Language
Preferred Name
Grade (2014-2015)
Generation (Jr,I,II)
Foster Child?
YES
Birth date
Ethnicity (circle one):
Birth place
Black
NO
Home Phone #
Hispanic
Anglo
Student lives with (Name):
Asian
Native American
Relationship:
Street Address:
City
State
Zip
State
Zip
Mailing Address (if differs)
City
Name of Local Public School Campus/District this student would attend if not attending any Charter School or private school:
List last 3 schools attended (at least list the last 3 years) and dates/grades while attending the school. (If more than 3 please use back of sheet).
School Name
School District
City
Grades/Dates of Attendance
Please list all siblings that are/will be attending Faith Family Academy:
_____________________________________________________
_______________________________________________________
_____________________________________________________
_______________________________________________________
_____________________________________________________
_______________________________________________________
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ENROLLMENT STUDENT PERSONAL INFORMATION cont.
Student’s Name ____________________________________________ Grade 2015-2016 _______________
1st CONTACT (Parent, Guardian, Other)
Last Name
E-mail address
First Name
Parent ID/Driver’s License #
Relationship
Employer & Address
Custody (circle one)
yes
no
Street Address
City/State/Zip
Work E-mail
Mailing Address
Home Phone
City/State/Zip
Mobile Phone
2ND CONTACT (Parent, Guardian, Other)
Last Name
E-mail address
First Name
Parent ID/Driver’s License #
Relationship
Employer Name and Address
Custody (circle one)
yes
no
Street Address
City/State/Zip
Work E-mail
Mailing Address
Home Phone
City/State/Zip
Mobile Phone
Please indicate academic level of child’s previous work: 90-100_______ 80-90_______ 70-80_______ below 70_______
Has child ever failed in school? Yes______ No______ When? ________________ Where? ______________
Explain: _________________________________________________________________________________
Has your child attended Summer School? Yes______ No______ When? ___________ Where? ___________
Explain: _________________________________________________________________________________
Has your child ever been in Special Education or Section 504? Yes_____ No_____ When? ______________
Explain:_________________________________________________________________________________
What was the last school your child was in a Special Education Program? ____________________________
Has your child ever been in a Gifted and Talented Program? Yes_____ No_______ When?_______________
Has child ever been eligible for a public education grant (PEGS)? Yes_______ No_______ When? ________
Explain: _________________________________________________________________________________
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FAITH FAMILY ACADEMY
Home Language Survey
Student’s Name__________________________________________________________________________
Nombre del estudiante
Last/Apellido
First/Nombre
Middle/Segundo Nombre
Date of Birth________________________________________________ IDS_________________________
Fecha de nacimiento
Month/Mes
Day/Dia
Yeat/Aho
School__________________________________ Grade__________ Date Enrolled___________________
Escuela
Grado
Fecha de entrada
Home Language Survey (informacion sobre el idioma quo se habla en casa)
1. What language is spoken in your home most of the time? _______________________________________
Cual es el idioma que mas se habla en su hogar?
2. What language does your child (do you) speak most of the time? ________________________________
Cual es el idioma que su Nino(a) habla mas?
3. What language did your child learn to speak first? ____________________________________________
Cual es el idioma que hijo(a) aprendio primero?
4. Where is your child’s place of Birth? (Country) _______________________________________________
Pals natal de nacimento?
5. Has your child lived outside the U.S. for two (2) or more consecutive years? Yes/Si _______ No______
Ha residido su hijo(a) fuera de los Estados Unidos por mas de dos (2) anos consecutivos?
6. Did your child attend school when residing outside the U.S.?
Asistio su hijo(a) a la escuela mientras estuvo fuera de Los Estados Unidos?
Yes/Si ______ No _______
7. Has your family moved during the last three years from one school district to another in the state of Texas
or across states?
Yes/Si ______ No _______
Se ha movido su familia durante los ultimos tres anos de un distrito escolar para otro en el estado de Tejas
6 a traves de todos los Estados Unidos?
8. Was this move due to the need to find temporary or seasonal work in agriculture or related areas such as
packing, processing, harvesting, crop, dairy produce, fishing, forest work, etc.? Yes/Si ______ No _______
fue la razon de su movimiento para buscar trabajo temporal de estacion en agricultura, o en areas
relacionadas para empacar, procesar, recoger producto de cosecha, productos lacteos, de pescaderia,
O de trabajos forestales?
Date of FIRST entry into ANY school in the U.S.A. _________________________________________________
Fecha de PRIMER ingreso en CUALQUIER escuela en los Estados Unidos.
Grade/Grado ______________ Month/Mes ___________________________________Year/Aho__________________
Signature of Parent __________________________________________________________ Date ________________
Firma del Padre/Guardian
Fecha
White-Cumulative Folder
ALL Yellow-ESL/Bilingual Department
SST-130 2/13/2006
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