2601 SW Port St. Lucie Blvd.
Port St. Lucie, FL, 34953
772-878-6889
www.achieversinstitute.net
MANDATORY DOCUMENTS FOR REGISTRATION COMPLETION
ENROLLMENT CHECKLIST
FORMS TO COMPLETE AND TURN IN TO ADMISSIONS OFFICE:
 APPLICATION CONTRACT
o TUITION AND FEES AGREEMENT (NOTARIZED)
o STUDENT PERSONAL DATA
o PARENT INFORMATION
o EMERGENCY CONTACT INFORMATION
o ABOUT YOUR CHILD
o STUDENT ACADEMIC HISTORY
o TRANSPORATION INFORMATION
o MEDICAL RELEASE & TREATMENT FORM
o SCHOOL OPERATING PRINCIPLES AGREEMENT FORM
 VIDEO / PHOTO AUTHORIZATION AND RELEASE FORM
 DRESS CODE
 BUS CONDUCT POLICY
 STUDENT DATA COLLECTION FORM
 STUDENT HANDBOOK ACKNOWLEDGEMENT FORM
DOCUMENTS TO BE SUBMITTED TO THE ADMISSIONS OFFICE:










COPY OF PARENT SOCIAL SECURITY CARD
COPY OF PARENT PICTURE ID
COPY OF CHILD’S SOCIAL SECURITY CARD
COPY OF CHILD’S BIRTH CERTIFICATE
CHILD’S MEDICAL EXAM FORM FROM FAMILY DOCTOR (yellow form)
CHILD’S IMMUNIZATION RECORD (blue form)
INDIVIDUALIZED EDUCATION PLAN (IEP) MCKAY SCHOLARSHIP ONLY
PREVIOUS SCHOOL WITHDRAWAL FORMS
RECENT TRANSCRIPTS FROM ALL PREVIOUS SCHOOLS ATTENDED
SCHOOL RECOMMENDATION FORM
1
2601 SW Port St. Lucie Blvd.
Port St. Lucie, FL, 34953
772-878-6889
www.achieversinstitute.net
Elementary/Middle/High School Enrollment Contract
20___ – 20___ Academic Year
Date: _____/_____/20____
PLEASE READ CAREFULLY BEFORE SIGNING
I/We hereby request that our child(ren) be enrolled at Achievers Institute for the ______ -- ______ academic year. It
is understood that our child(ren) will be enrolled for the entire academic year and that Achievers Institute has
obligated itself in regards to the number and quality of faculty, size of facility, amount of supplies and equipment:
and the viability and sustainability of its program(s) is reliant upon such enrollment.
No refund or reduction of any charges will be made due to withdrawal, absence, or illness. The fact that the school
allows tuition to be paid in one or eleven installments does not create a fractional contract or in any way relieves the
parent of the financial responsibility for the entire year’s tuition and fees. Achievers Institute reserves the right to
expel any student due to disciplinary issues or absences totaling two or more weeks per school year and to withhold
transcripts and all academic records until the tuition and fees have been paid in full.
It is understood that attendance at Achievers is a privilege and not a right. All students are enrolled on a provisional
basis. No one student is guaranteed enrollment each year. It is the right of the institution to refuse or rescind
admission based on the parent/ student’s ability to adhere to policies and procedures and maintain acceptable
academic, social, and spiritual progress.
**All fees paid with this application are Non--Refundable/Non Transferrable**
**Enrollment fees for Step-Up Applicants are 100% Refundable if scholarship is not received**
________________________________
Parent/Guardian Name
________________________________
Parent Signature (Required)
________________________________
Child’s Name
________________________________
Administrator Signature
ENROLLMENT FEE $200 NON-REFUNDABLE
**Enrollment and Tuition fees do not include: Transportation, Lunch, Uniforms ($2.50 per day)**
2
2601 SW Port St. Lucie Blvd.
Port St. Lucie, FL, 34953
772-878-6889
www.achieversinstitute.net
Elementary/Middle/High School Enrollment Contract
TUITION FEES & PAYMENT PLANS
Tuition Includes: K-12 teacher and administrator salaries, instruction tools/materials, student insurance, online services,
special classes, dual enrollment (Grades 11 & 12), fine arts (music, drama), physical education, and vocational and
culinary arts training.
PLEASE READ CAREFULLY BEFORE SIGNING & SELECT ONE PLAN
Tuition Payment Programs
Grade Levels
Plan A:
One Payment
Plan B:
10 Payments/ Month
K
$5,275.00
due by August 1st , __
$527.50
(Aug. 1st____to May 1st____)
Grade 1 – 4
$5,590.00
due by August 1st , ____
$559.00
(Aug. 1st____to May 1st____)
Grade 5-8
$6,400.00
due by August 1st ,____
$640.00
(Aug. 1st____to May 1st____)
Grade 9-12
$6,640.00
due by August 1st,____
$664.00
(Aug. 1st____to May 1st____)
Special Discounts:
 ONE PAY PLAN A – 5% Discount on annual tuition – Payment due by August 1st
 Early Registration - $50 Discount on Matriculation Fees if registered by June 14th of each year.
 10% multiple child discount for the 2nd + child(ren)
Special Services Fees:
 K- 8 Introductory Assessment Fee- $50.00 Placement Test per student; Science Lab Fees: already included with
registration.
 Instructional Fees: Required for additional instruction for students scoring two or more grade levels below, or
having other learning disabilities. The amount is based on IEP Assessment.
 Resource Fees: This fee is mandatory until students pass aptitude tests at their grade level.
 TUITION PAYMENTS ARE DUE ON THE FIRST OF EACH MONTH. A LATE FEE OF $20 WILL BE APPLIED
TO ALL ACCOUNTS AFTER THE 5TH OF EACH MONTH. All NSF checks are subject to a $35.00 service
charge.
Additional Fees:
 A $25 late fee will be applied each month to accounts delinquent for more than 30 days.
 10 unexcused tardies in a grading period will result in a $25 reregistration fee
Please be reminded that no refund or reduction of any charges will be made due to withdrawal, absence, or
illness. The parent is responsible for the entire year’s tuition and fees.
I, the parent/guardian of the above child(ren) am in full agreement with the policies and standards of Achievers
Institute. I have read the financial requirements and agree to abide by all of the above.
Parent/Guardian Signature: ______________________________________ Date: _____/_____/20____
Witness ____________________ Date ____________ Notary Name___________________________
3
2601 SW Port St. Lucie Blvd.
Port St. Lucie, FL, 34953
772-878-6889
www.achieversinstitute.net
OFFICE USE ONLY / PLEASE DO NOT WRITE BELOW THIS LINE.
________________________________________________________________________________________
Grade: [KGN] [1st] [2nd] [3rd] [4th] [5th] / [6th] [7th] [8th]
CLASSROOM TEACHER: _________________________
CLASS: _________________
Payment: Check/MO# __________________________ Credit/Debit Card: Rec. #: __________________ Reg. $__________ Books $__________
Technology Fee $__________ Deposit $__________________
Graduation Fees (Due Feb. 1) K-$50.00; G8-$100.00; G12-$150.00
Total Paid $____________________
4
2601 SW Port St. Lucie Blvd.
Port St. Lucie, FL, 34953
772-878-6889
www.achieversinstitute.net
Application Form
(All Information and documentation must be provided in order for the application to be processed)
STUDENT PERSONAL DATA: Please Print!!
Date of Entry:
/
/
Re-registration
Y/N
Password
Last Name:
First Name:
SSN:
DOB:
/
/
Gender:
F/M
PARENT INFORMATION:
Please Print: (Last, First, Middle Initial)
Mother or Legal Guardian’s Name:
Father or Legal Guardian’s Name:
Residence Address:
Residence Address:
City/State/Zip Code:
City/State/Zip Code:
Home Phone:
Home Phone:
Cell Phone:
Cell Phone:
Work Phone:
Work Phone:
Mother’s Occupation:
Father’s Occupation:
E-mail:
E-mail:
Current Employer:
Current Employer:
Social Security:
Social Security:
Does student reside at this address? Yes or No
Does student reside at this address? Yes or No
Is a parent or individual forbidden by court from having equal access to the student or student’s record? Yes/No
- If YES, please print clearly the full name of the individual.
Name ______________________________________ Relationship ________________________________
5
2601 SW Port St. Lucie Blvd.
Port St. Lucie, FL, 34953
772-878-6889
www.achieversinstitute.net
EMERGENCY CONTACTS: (Please update every quarter or immediately when there is a change)
Full Legal Name:
Relationship:
Street Address:
City/ State/ Zip:
Phone#:
Alt. Phone#:
Full Legal Name:
Relationship:
Street Address:
City/ State/ Zip:
Phone#:
Alt. Phone#:
Full Legal Name:
Relationship:
Street Address:
City/ State/ Zip:
Phone#:
Alt. Phone#:
Please Help Us Learn About Your Child
Does your child have special needs? No __ Yes__. If yes, please explain: ___________________________
__________________________________________________________________________________________
Please tell us about your child’s strengths/likes: _________________________________________________
__________________________________________________________________________________________
Please tell us about your child’s dislikes: _______________________________________________________
__________________________________________________________________________________________
Is your child suffering from any known disease or health issues? (For example: diabetes, heart problem, asthma,
severe allergies, etc.) Yes/No
If yes please specify: ________________________________________________________________________
Is your child allergic to any type of foods? Yes/No
If yes please specify: ________________________________________________________________________
Number of Siblings: ______
Ages: ______,
______,
______,
______,
______,
______
Student lives with (check one)
Both Parents
Grandmother
Guardian
Mother only
Grandfather
Mother & Stepfather
Father only
Both Grandparents
Father & Stepmother
Other(specify)
6
2601 SW Port St. Lucie Blvd.
Port St. Lucie, FL, 34953
772-878-6889
www.achieversinstitute.net
Academic History:
Name of All Institutions
Attended
Year(s) Attended
(M/Y)
Ex. (08/09-06/10)
Grade(s)
Successfully
Completed
Reason(s) for Withdrawal
TRANSPORTATION TO & FROM SCHOOL (Check one)
___Parent will transport student
___Student will take public transportation
___Parent will make transportation arrangements with school
___Other(specify)______________________________
Please list the ‘Persons Permitted’ to pick up and drop off your child. Your Child will not be released by Achievers
Institute without proper legal Identification from the authorized person(s).
Full Legal Name
Phone#
Relationship
Full Legal Name
Phone#
Relationship
Full Legal Name
Phone#
Relationship
I have read, understand and agree to the terms and conditions of this contract. To the best of my knowledge, all
answers that I have provided to the questions on this application have been truthful.
Parent/Legal Guardian:______________________________________________
Date:________________
7
2601 SW Port St. Lucie Blvd.
Port St. Lucie, FL, 34953
772-878-6889
www.achieversinstitute.net
MEDICAL TREATMENT RELEASE AND AGREEMENT FORM
DOCTOR’S INFORMATION (Please Print)
Doctor’s Name_____________________________
Medical Facility:_______________________________
Address __________________________________
Phone Number: _______________________________
In the event my child becomes ill or is injured while under school supervision, I give the school permission to take the
following steps:
1. Contact a parent of the student and follow their instructions;
2. In the event neither parent can be reached, contact the student’s physician and follow his/her instructions;
3. If the student’s physician can be reached, the school authorities will use their own discretion in contacting a properly
licensed practicing physician and follow his/her instructions;
4. I hereby authorize, appoint and empower the school authorities of Achievers Institute to take my child to a licensed
and practicing physician if my child needs medical or surgical treatment and I (the parent or guardian) cannot be
reached by phone.
5. I hereby release Achievers Institute authorized personnel, from any liability which might arise from the giving of
medical treatment or surgical services as soon as reasonably possible after the need arises.
6. I give permission for my child to take part in all school activities, including school sponsored trips from the school
premises, and absolve the school from liability to me or my child because of any injury to my child at school or during
any school activities.
7. I, the parent or legal guardian agree not to send my child to school if he or she is sick.
Please fill out and sign the information below so that we may complete your child’s file.
I, __________________________________authorize Achievers Institute to seek medical treatment for my
son/daughter, ____________________________ in the event of an emergency. I also give authorization for the health
facility or physician to provide medical treatment as necessary. I assume responsibility for payment for all medical
services rendered.
Parent /Legal Guardian’s Signature: _______________________________ Date: _________________
Parent/ Legal Guardian’s Signature: ________________________________ Date: _________________
Name of Insurance: _________________________
Group Number: _______________________________
8
2601 SW Port St. Lucie Blvd.
Port St. Lucie, FL, 34953
772-878-6889
www.achieversinstitute.net
Summary School’s Operating Principles & Practices
Dear Parents:
Welcome to our school!!
Thanks for your interest in our school. Below are some of the overarching principles that govern the programs
and practices of Achievers Institute of Science, Art & Technology. We believe that it is important for you to
understand the principles and practices that summarize our Christ-centered philosophy and mission.

Achievers Institute is a Faith-based Institution;

Achievers Institute is a Non-denominational Institution

Achievers Institute believes that parents have the right to choose a school that they believe will best fit
and meet the educational and spiritual needs of their children;

Achievers Institute’s curricula and programs promote and uphold a Christ-Centered approach to
teaching and learning;

Achievers Institute uses a holistic approach in planning for students’ educational experiences – Meeting
the needs of their students through the development of their mental, spiritual and physical faculties;

Besides the required core-curricula for the State of Florida, Achievers Institute uses the A BEKA
curricula, to develop and implement rigorous educational courses and programs that foster positive
character development through the teaching of core Christ-centered values;

Achievers Institute admission policies specifically state that it does not discriminate on the basis of
race, religion, nationality, ethnic origin or gender;

Achievers Institute requires all parents of prospective students to sign a document that has outlined the
principles that govern the institution, signifying that they are aware, understand and will comply with the
principles under which the school operates;

Your signature acknowledges that your child will abide by the operating Christ-centered principles and
practices of this institution; gives the institution permission for your child to be included in prayer and
gives your support for character building.
Acknowledgement Parent/ Guardian:
I have read; and I ____________________________________understand and agree that my child
___________________________ will comply with the Christ-centered principles and practices of
Achievers Institute. Date:____________________.
9
2601 SW Port St. Lucie Blvd.
Port St. Lucie, FL, 34953
772-878-6889
www.achieversinstitute.net
PARENT/GUARDIAN AUTHORIZATION & RELEASE FORM
During the school year our students will participate in many academic events which may take place at our
school, on field trips, and off campus.
For example, the local press and television are taking a particular interest in our school and the quality
education we provide. I would appreciate if you would sign and return the permission form below for your
child’s participation in school video and photography events.
The permission given will be an agreement for the school year and will be renewed each new school year.
Sincerely,
Dr. Claudette Giscombe
Director
VIDEO/PHOTOGRAPHY PERMISSION
I, give permission for my child to be videotaped and/or photographed for school activities. I understand that the
video/photographs may be used for the yearbook, marketing, and/or public relations promotion.
STUDENT
_____________
DATE
PARENT/GUARDIAN SIGNATURE
_____________
DATE

I do not give permission for my child to be videotaped and/or photographed for school activities

I do give permission for my child to be videotaped and/or photographed for school activities
Achievers Institute **Solutions for Academic Excellence**
10
2601 SW Port St. Lucie Blvd.
Port St. Lucie, FL, 34953
772-878-6889
www.achieversinstitute.net
Achievers Institute of Science, Art & Technology Student Dress Code
The purpose of a dress code in a school is to minimize distractions and to help students learn to keep
themselves neat, modest, and well-groomed. A dress code encourages students to express their individuality
through personality and academic achievements; not with outward appearances. By implementing a dress
code our institution will be able to create a sense of school pride and belonging. Coming to school in dress
code, is a daily requirement and violations will result in disciplinary actions as listed in the Code of Student
Conduct.
Achievers Institute values the dress code and looks to the student and families to comply with the
rules. We expect that parents will work with school personnel in supporting and enforcing the dress code.
IMPLEMENTED UNIFORM PLAN:
ELEMENTARY SCHOOL
MIDDLE SCHOOL
HIGH SCHOOL
Long pants
Long pants
Long pants
Colors: Black, Navy Blue,
Khaki
Colors: Black, Navy Blue,
Khaki
Colors: Black, Navy Blue,
Khaki
Knee length,
Cargo/Bermuda
Knee length,
Cargo/Bermuda
Knee length,
Cargo/Bermuda
Colors: Black, Navy Blue,
Khaki
Colors: Black, Navy Blue,
Khaki
Colors: Black, Navy Blue,
Khaki
SKIRTS/SKORTS
Knee length
Knee length
Knee length
and DRESSES
Colors: Black, Navy Blue,
Khaki, Burgundy Dresses
Colors: Black, Navy Blue,
Khaki
Colors: Black, Navy Blue,
Khaki
SHIRTS
Solid color short sleeve
polos.
Solid color short sleeve
polos.
Solid color short sleeve
polos.
Colors: White, Light Blue,
Beige, Burgundy, Navy Blue,
Autumn Orange (Friday
only), Spirit Shirt (Fridays
only)
Colors: White, Light Blue,
Beige, Burgundy, Navy
Blue, Autumn Orange
(Friday only), Spirit Shirt
(Fridays only)
Colors: White, Light Blue,
Beige, Burgundy, Navy
Blue, Autumn Orange
(Friday only), Spirit Shirt
(Fridays only)
PANTS
SHORTS
11
2601 SW Port St. Lucie Blvd.
Port St. Lucie, FL, 34953
772-878-6889
www.achieversinstitute.net
SWEATERS
JACKETS
COATS
A collared shirt must be
worn underneath all
sweaters except for
turtlenecks.
A collared shirt must be
worn underneath all
sweaters except for
turtlenecks.
A collared shirt must be
worn underneath all
sweaters except for
turtlenecks.
Color: Burgundy
FOOT AND LEG
WEAR
BELT
TIES
Black (leather like) dress
shoes with socks (black,
white, navy, or beige only)
must be worn daily. No
emblems, decorations or
designs. Boots are NOT
permitted.
Black (leather like) dress
shoes with socks (black,
white, navy, or beige only)
must be worn daily. No
emblems, decorations or
designs. Boots are NOT
permitted.
Black (leather like) dress
shoes with socks (black,
white, navy, or beige
only) must be worn daily.
No emblems, decorations
or designs. Boots are NOT
permitted.
Black tennis shoes may be
worn on “Dress Down Days”.
Black tennis shoes may be
worn on “Dress Down
Days”.
Black tennis shoes may be
worn on “Dress Down
Days”.
A belt is required if the
garment has belt loops
A belt is required if the
garment has belt loops
A belt is required if the
garment has belt loops
Color: Black
Color: Black
Color: Black
Color: Burgundy
FIELD TRIPS:
 The required uniform is an orange polo with khaki bottoms (or jeans when permitted).
OTHER DRESS CODE RULES:
 Shirts (including undershirts) must be tucked in.
 Shoes must be safe and appropriate.
 Clothing that is too tight or too loose is not appropriate for school.
12
2601 SW Port St. Lucie Blvd.
Port St. Lucie, FL, 34953
772-878-6889
www.achieversinstitute.net
ACCEPTABLE:
 Jackets, Sweaters or Coats are acceptable during the winter/cold weather as long as it meets regular
dress code.
 Hats and hoodies are permitted during the winter but may not be worn in the building.
 Jewelry and personal embellishments must be discreet and not present a distraction to the learning
environment.
 Jeans/Denim bottoms (pants, shorts, skirts) are permitted only on Dress Down Days.
**Parents will be informed when “Dress Down Days” are scheduled.
NOT ACCEPTABLE:
 Flip flops, slippers, open toe shoes.
 Distractive embellishments, emblems, or decorations on clothing
 No unnatural colored hairstyles; hair must be well-groomed.
 Make-up will not be worn.
 Underwear or exposed midriff skin must not be visible at any time.
FINANCIAL HARDSHIPS:
 Achievers Institute will make provisions for students, who by reason of financial hardship, cannot
comply with the mandatory dress code policy. In order to make the uniforms affordable for parents,
uniforms can be purchased at Wal-Mart or any local department store for a reasonable price.
13
2601 SW Port St. Lucie Blvd.
Port St. Lucie, FL, 34953
772-878-6889
www.achieversinstitute.net
BUS CONDUCT POLICY
Regular / Field Trips
The importance of proper conduct while waiting for, boarding, riding or disembarking from a bus cannot be
overemphasized. Any behavior that distracts the bus driver instantly endangers all. In the interests of safety, all students
should understand and parents are urged to impress upon their children the necessity for strict compliance with the
following rules:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Students are to remain well out of the roadway while waiting for the bus.
Students must from a queue to get on and off of the bus.
Getting on and off the bus should be done in an orderly manner.
Students are to remain seated while the bus is in motion.
No part of the body should ever be extended outside the bus.
Aisles should be kept clear at all times.
Conversations should take place in normal tones of voice. A sudden scream or yell is especially
dangerous.
Nothing should be thrown either in or from the bus.
Smoking on the school bus is strictly forbidden.
Crowding, pushing, shoving, etc. are not only unnecessary, but dangerous as well.
Attitudes of helpfulness and cooperation will do much to insure safe comfortable bus transportation
for all.
Eating, drinking, or chewing gum is not permitted on the bus.
Students will be responsible for VANDALISM. RESTITUTUION will be required.
Reptiles, bugs, animals or marine life (dead or alive) are not permitted on the bus.
Band instruments, school projects or special equipment which interfere with the seating or safety of
others are not permitted on the school bus.
BUS REGULATIONS AND SEATING FOR REGULAR RIDERS
1. Students must ride their assigned bus and each must board and depart at a designated bus stop. Students
must present a written request from the parent/guardian to the Principal or Designee for approval of
requested changes.
2. Students are requested to be at the bus stop 10 minutes before scheduled pick-up as the bus will not wait
beyond the scheduled pick-up time.
3. Parents are responsible for students for students prior to boarding and after departing from the bus.
4. Students will board, depart, and cross the roadway as per instructions from the Bus Driver.
5. The Bus Driver must assign seats and students will sit in their assigned seats at all times.
14
2601 SW Port St. Lucie Blvd.
Port St. Lucie, FL, 34953
772-878-6889
www.achieversinstitute.net
NOTE: Attention of students and parents is directed to the State School Law which states in part that, “A student may be
excluded from bus transportation for disciplinary reasons by the principal, and his parents shall provide for his
transportation to and from school during the period of such exclusion.”
Buses will leave the school grounds shortly after the 2:30 p.m. dismissal. For those regular riders engaged in supervised
after-school programs, late buses will be provided and are scheduled to leave the school grounds at approximately 3:15
p.m. Parents, please note that bus arrangements must be made when you sign for your child’s after after-school
program.
_______________________________
Parent Signature
_________________________________
Student Signature
15
2601 SW Port St. Lucie Blvd.
Port St. Lucie, FL, 34953
772-878-6889
www.achieversinstitute.net
FLORIDA DEPARTMENT OF EDUCATION
STUDENT DATA COLLECTION FORM
Dear Parent or Guardian,
Every school district in Florida is required to report to the Florida Department of Education each year student
data by race and ethnicity categories that are set by the federal government. The Department of Education
does not report individual student data to the federal government but does report the total number of
students in various categories in each school. These reports help us keep track of changes in student
enrollments and ensure that all students receive the education programs and services to which they are
entitled.
The federal government has adopted new standards for collecting and maintaining ethnicity and race data
that will allow individuals to more accurately report their origins. As a result of this, you have the opportunity
to update the student data for your child. With the new reporting categories, you may now identify your child
by ethnic group and by one or more racial groups.
Please answer all questions below by checking “YES” or “NO” for each of your children:
ETHNICITY:
1. Is the student of Hispanic/Latino origin?
Yes____ No____
RACE:
2.
3.
4.
5.
6.
Is the student American Indian or Alaska Native?
Is the student Asian?
Is the student Black or African American?
Is the student Native Hawaiian or other Pacific Islander?
Is the student White?
Student Name:
___
Yes____
Yes____
Yes____
Yes____
Yes____
No____
No____
No____
No____
No____
Grade: ________________
School District where Private School is located: Saint Lucie_________________________________
Name of Private School: Achievers Institute _____________________________________________
Parent/Guardian Name (Print)_________________________________________________________
Parent/Guardian Signature
____
Date_____________
16