Preference Form

Preference Form

School Year 2021-22
Select Preference Form: *
Round One of enrollment for TK, K-5 and 6-8 will take place from January 4 – February 5, 2021.
Round One of enrollment for BHS ended on December 18th, 2020. Round Two will begin on March 24, 2021.
Grade in 21-22: *
Grade in 21-22: *
Elementary School
Grade in 21-22: *
Middle School
Grade in 21-22: *
High School
Grade in 21-22: *
Independent Study
Email Address *
Make sure it's correct. Your completed form will be sent to this email address.
Name of Student as it appears on birth certificate. *

First Name Middle Name Last Name

TRANSITIONAL KINDERGARTEN
Students born between September 2 – December 2, 2016 must attend a transitional kindergarten program.

The transitional kindergarten program follows the guidelines of the California Department of Education. It is aligned with the changing entry date for kindergartners and offers placement for students who, prior to the new law, would have been eligible for regular kindergarten.

Please Note: The assigned school will be for transitional kinder only, you will need to apply for a kindergarten assignment in January 2022.

ELEMENTARY SCHOOL

Ranked School Preferences
District-Wide Dual Immersion and Spanish Bilingual Program

This lottery runs first. These selections will be considered before the rankings in the Regular program selection.

Thousand Oaks Bilingual Program is available for grades 4-5 only. Assignment priority is given to Northwest families. Transportation provided only to Northwest families.
Are you interested in enrolling your child in the Thousand Oaks Bilingual Program? *

Yes, I am interested in the Spanish Bilingual Program No
Are you interested in enrolling your child in the Sylvia Mendez Dual Immersion Program? *

Yes, I am interested in Dual Immersion No
Which program is your first choice? *

Thousand Oaks Bilingual Program Sylvia Mendez Dual Immersion Program
Thousand Oaks Bilingual (3rd - 5th grade only)
Only rank if interested in Spanish Bilingual Program. Assignment priority to Northwest families. Transportation provided only to Northwest families.
Sylvia Mendez Dual Immersion
Only rank if interested in Dual Immersion.
Regular Program
Which BUSD Zone are you in? *

Northwest Zone Central Zone Southeast Zone
Not sure? Click here to find your BUSD Zone.
Click and drag the Northwest schools below in order of preference: *
Click and drag the Central schools below in order of preference: *
Click and drag the Southeast schools below in order of preference: *

MIDDLE SCHOOL

Ranked School Preferences
District-Wide Dual Immersion Program

For 6th-grade students currently attending BUSD dual immersion program.
Longfellow Dual Immersion (6th graders only)
Regular Program
Click and drag the schools below in order of preference: *
Students are given priority to their zoned schools (King or Willard) provided space is available. Out of zone students will be considered after in zone students have been assigned. Click here to find your BUSD Zone.

HIGH SCHOOL
School Preference *

Berkeley High School Berkeley Technology Academy (16+)
Berkeley Technology Academy is available to students 16 and older in grades 10-12.

Please note that a meeting with school administrators is required for enrollment into BTA. You will recieve information about this after submitting enrollment documents.

INDEPENDENT STUDY
Please note that a meeting with independent study staff is required for enrollment. You will recieve information about this after submitting enrollment documents.

Learn more about Berkeley Independent Study.

STUDENT INFORMATION
Student Name: {nameOf108}
Date of Birth *

Month Day Year
Date
Age *
Gender *

Male Female Non Binary

Assignment of Students

Students will be admitted to schools in accordance with six established priority categories. A computer assignment system will assign students on a random basis within a priority for each grade level within each school. Priority requirements are as follows:

1st priority: BUSD students currently attending the school (with the exception of transitional kinder) and living within attendance zone

2nd priority: BUSD students currently attending the school (with the exception of transitional kinder) and living outside the attendance zone

3rd priority: Berkeley residents who are siblings of any student currently attending the school on the basis of the first or second priority and who will continue in attendance for the 2020/21 school year

4th priority: Berkeley residents not currently attending the school and living within the attendance zone

5th priority: Berkeley residents not currently attending the school and living outside the attendance zone

6th priority: All non-Berkeley resident students requesting inter-district transfers
I verify that the information on this form is complete and true.
Signature *

Clear
Date *

Month Day Year
Date

DECLARATION OF RESIDENCY
I declare that the Berkeley residency information provided below is true and correct.
Parent/Guardian Name: *

First Name Last Name
Email Address: *
example@example.com
Cell Phone: *

Area Code Phone Number
Landline Phone:

Area Code Phone Number
Work Phone:

Area Code Phone Number
Primary Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
The following children under the age of 18 reside in the Berkeley household, and I am attaching the required proofs of residency.
Number of children in household: *
Child 1
Child's Name: *

First Name Last Name
Date of Birth: *

Month Day Year
Date
Current School: *
Current Grade: *
Child 2
Child's Name: *

First Name Last Name
Date of Birth: *

Month Day Year
Date
Current School: *
Current Grade: *
Child 3
Child's Name: *

First Name Last Name
Date of Birth: *

Month Day Year
Date
Current School: *
Current Grade: *
Child 4
Child's Name: *

First Name Last Name
Date of Birth: *

Month Day Year
Date
Current School: *
Current Grade: *
Child 5
Child's Name: *

First Name Last Name
Date of Birth: *

Month Day Year
Date
Current School: *
Current Grade: *
Child 6
Child's Name: *

First Name Last Name
Date of Birth: *

Month Day Year
Date
Current School: *
Current Grade: *
I certify that my children and I are residents of the city of Berkeley. Depending on the individual student’s circumstances at times it may be necessary to conduct residency verifications to ascertain the student’s domicile. If residency verification efforts determine that we do not reside in Berkeley, I realize that my child may be dropped from enrollment and returned to his/her district of residence within twenty (20) days.

I understand that I must notify the Admissions Office of any changes in domicile within ten (10) days. If I move within Berkeley, I must also submit the required proofs of Berkeley residency within thirty (30) days to the District’s Admissions Office. If I move out of Berkeley, at that time, I may apply for an interdistrict permit, which, if approved, may allow my child to continue in the Berkeley public schools.

This declaration is made under the penalty of perjury under the laws of the State of California and entered on the date below in Berkeley, Alameda County, California.
Signature *

Clear
Relationship to student(s): *
Date *

Month Day Year
Should be Empty:

TRANSITIONAL KINDERGARTEN

ELEMENTARY SCHOOL

MIDDLE SCHOOL

HIGH SCHOOL

INDEPENDENT STUDY

STUDENT INFORMATION

PARENT/GUARDIAN INFORMATION

Parent 1

Parent 2

DEMOGRAPHIC INFORMATION

EDUCATIONAL BACKGROUND

DECLARATION OF RESIDENCY

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6