* Yellow Packet - Student Application

Welcome to the Virtual Enrollment Student Application!

This portion of the Enrollment Application is to be filled out by Students! Please make sure you have at least 25 minutes to fill out this portion.
Today's Date

MonthDayYear
Date
Full Name

First NameLast Name
Date of Birth
OSIS Number
Street Address
Apartment Number
Borough
State
Zip Code
Email
Parent/Guardian Full Name
Home Phone Number
Parent/Guardian Cellphone Number
Emergency Contact Full Name
Emergency Contact Phone Number
Last HIGH SCHOOL Attended, What school are you coming from?
Now, please take some time to respond to the following Essay Prompt. Students must complete the essay independently, cannot be parent or guardian.

Part of Liberation's Mission is built on "Sankofa" which means:

“We must go back and learn our past to understand who we are today; thereby empowering ourselves to move forward.”

“We must learn from our past mistakes in order to move forward.”

In a brief essay (1-2 paragraphs) explain why you want to be a student at Liberation Diploma Plus High School.

Please include responses to the following:

WHAT SCHOOL ARE YOU COMING FROM?

WHY DID YOU END UP HERE?

WHAT DOES THE ABOVE QUOTE MEAN TO YOU?

WHAT ARE YOU COMMITTED TO DO IN ORDER TO BE SUCCESSFUL HERE AT LIBERATION?

WHAT ARE YOUR EXPECTATIONS OF LIBERATION?

PLEASE WRITE 1-2 paragraphs ANSWERING THESE QUESTIONS!

PLEASE TRY YOUR BEST. This is your opportunity to reflect on what you need in order to return to school and graduate with your high school diploma!

You will be asked to talk about your essay in your in-person student interview.
Please type your essay in the box below. You can also Copy & Paste into the box.*
Please answer the following short answer questions designed to get to know you better! Tell us more about yourself...

Please do not skip any questions in this portion! If you miss questions you will be asked to complete them during your in-person student interview.
Why do you want to attend Liberation Diploma Plus High School?
My goal for the future is:
What makes a good school?
How can my parents/guardians assist me in reaching my goals?
Who do you live with: (List names and their relationship to you)
What do you like to do to have fun? How do you spend your spare time?
What are your best subjects?
What subjects do you need help in or just are not your favorite?
What is your best guess as to why you experienced problems in your present/last school?
When problems occur how do you respond? How do your parents/guardians respond?
What should we know about you as a person?
What are your short term goals (6 months a year) and what do you need to achieve them?
What are your long term goals (1 year + ) and what do you need to achieve them?
What would you like to do after high school?
Give us an example of a typical day for you, a timeline from when you wake up in the morning until the time you go home?
How can the staff at Liberation Diploma Plus High School help you to complete your goals?
If you had a conflict with a staff member or a student at school what would you do? Would you leave school? Would you talk to someone?
What kind of activities would you like to be a part of in school/after school?
Please answer the next following questions to the best of your ability...

If you are unsure or if a question does not apply, you may leave it blank.
Are you on any forms of Medication?
Do you have any Emotional Challenges:
Are you a Special Education Student? Do you have an IEP? If yes, please write: Yes IEP.
Date of Most Recent IEP

MonthDayYear
Date
Do you receive any of the following IEP services?

Counseling ServicesSpeech TherapyOccupational TherapyPhysical Therapy
Other
Are you an English Language Learner? If yes, what is your Level?
Primary Language
Have you ever been Incarcerated?
Are you currently on Probation?
Are you currently on Parole?
Have you ever been Suspended? If yes, what type?

Superintendent SuspensionPrincipal Suspension
And finally... Last, but not Least!

Please read the following School Policy and enter your signature.
Liberation Phone/Electronic Device Policy
- Phones must be turned in at the beginning of the day, along with Apple watches and any other Wi-Fi enabled devices. Once a student goes through scanning and it is verified that the student has a phone, the phone must be handed to the assigned staff member. Phones will be kept in a locked cart and will be returned to students at the end of the school day. There will be no exceptons to this rule.
Student Signature:*

Clear
Please take a minute to scroll up and review your responses!

Once you are ready, click Submit Completed Form! You can also Save and continue working later!
Should be Empty:

Welcome to the Virtual Enrollment Student Application!

Please answer the following short answer questions designed to get to know you better! Tell us more about yourself...

Please answer the next following questions to the best of your ability...

And finally... Last, but not Least!

Please take a minute to scroll up and review your responses!