Updated Capital Village School Enrollment Form 2021-22

Enrollment Form Directions:

Step 1: Please fill out this enrollment form online.

Step 2: Sign electronically through DOCUHUB OR bring to the school the 1st Round enrollment documents (below) MUST BE COMPLETED BY MAY 3, 2021

DC Residency Verification Spanish Version DC Residency Verification
Home Language Survey Spanish Version Home Language Survey
Capital Village Seat Acceptance Form
Government-issued identification of the person enrolling student (Copy)
Student’s original birth certificate (Copy)
Acceptable form of DC Residency (See Below) (Copy)

One of the following items shall establish District residency for the purposes of this chapter:

Proof of payment of District personal income tax, in the name of the person seeking to enroll the student, for the tax period closest in time to the consideration of District residency
A pay stub issued less than 45 days prior to consideration of residency in the name of the person seeking to enroll the student that shows his or her District residency and evidence of the withholding of District income tax;
Current official documentation of financial assistance received by the person seeking to enroll the student, from the District Government including, but not limited to Temporary Assistance for Needy Families (TANF), Medicaid, the State Child Health Insurance Program (SCHIP), Supplemental Security Income (SSI), housing assistance, or other governmental programs;
Confirmation, based upon completion and submission of a tax information authorization waiver form, by the District Office of Finance and Revenue of payment of District income taxes by the person seeking to enroll the student;
Current official military housing orders showing residency in the District of the person seeking to enroll the student; or
A currently valid court order indicating that the student is a ward of the District.

Providing 2 of the following items shall also suffice as proof of residency in the District:

A current motor vehicle registration in the name of the person seeking to enroll the student and evidencing District residency;
A valid unexpired lease or rental agreement in the name of the person seeking to enroll the student, and paid receipts or canceled checks (for a period within 2 months immediately preceding consideration of residency) for payment of rent on a District residence in which the student actually resides;
A valid unexpired District motor vehicle operator's permit or other official non-driver identification in the name of the person seeking to enroll the student; and
Utility bills (excluding telephone bills) and paid receipts or cancelled checks (from a period within the 2 months immediately preceding consideration of residency) in the name of the person seeking to enroll the student that show a District residence address.

Step 3: Submit Remaining 2nd Round Enrollment Documents by June 30, 2021

DC Child Physical Health Certificate
DC Child Oral Health Certificate
Copy of IEP/504 plan(If applicable)
Copy of student records/report card from previous schools

Student First Name / Nombre del Estudiante*

Student Last Name/ Apellido del Estudiante *

Date of Birth/ Fecha de Nacimiento *

Gender

Street Address/ Dirección*

Apt. #

City/ Ciudad *

State/ Estado*

Zip Code/ Código postal*

Please indicate the name of the current parent/family referred you?*

What grade is your student enrolling?*

5th grade6th grade7th grade

What ward do you currently live in? ¿En qué barrio vives?*

Housing Status (Select Only One)*

Please indicate if the parent/guardian is currently an active duty member of the military (Select Only One)*

YESNO

Race/ Carrera (Check all that apply)*

Ethnicity/ Etnicidad*

Hispanic/LatinoNo

Primary Home Language Spoken*

How will your student get to and from school?*

Will your student need Before Care or After Care?*

Before Care OnlyAfter Care OnlyBefore and After CareMy student will not need either

Does your child have any learning needs?*

YesNo

If you responded yes to the above question, please specify.

IEP504 PlanOther

Please give a overview of your student's needs:

Does your child have any health, medical, or nutritional needs (allergies, asthma, and dietary needs) that would be important for school staff to know?*

YesNo

If you responded yes to the above question, please specify.

Last Name*

First Name*

Relationship to student*

Primary Phone Number*

Type of Phone Number*

HomeWorkCell

Secondary Phone Number

Type of Phone Number

HomeWorkCell

E-Mail Address

Last Name

First Name

Relationship to student

Primary Phone Number

Type of Phone Number

HomeWorkCell

Secondary Phone Number

Type of Phone Number

HomeWorkCell

Is this individual authorized to pick up your child from school at dismissal?

YesNo

E-Mail Address

First Name*

Last Name*

Relationship to student*

Primary Phone Number*

Type of Phone Number*

HomeWorkCell

Is this individual authorized to pick up your child from school at dismissal?*

YesNo

First Name*

Last Name*

Relationship to student*

Primary Phone Number*

Type of Phone Number*

HomeWorkCell

Is this individual authorized to pick up your child from school at dismissal?*

YesNo

Last Name

First Name

Relationship to student

Primary Phone Number

Type of Phone Number

HomeWorkCell

Is this individual authorized to pick up your child from school at dismissal?

YesNo

Please list any additional people who are able to pick up the student from school.

Please list any allergies that your child has.*

Please list any dietary restrictions that your child has.*

I give permission to Capital Village PCS and other Capital Village pre-approved organizations to use photographs, video, and/or other similar media of my child to support the school's marketing, business, and operational efforts.*

YesNo

How did you learn about Capital Village PCS?*

If you selected "Parent Referral," please tell who referred you.

Electronic Parent/Guardian Signature (First/Last Name) USE YOUR FINGERTIP TO SIGN.

Date (MM/DD/YYYY)*

Thank you for completing the Online Enrollment Form for Capital Village PCS. In order to complete your enrollment, you must submit proof of DC residency online or through the mail.

One (1) of the following is acceptable:

Paystub, issued within a 45-day window prior to the date of your submission, showing withholding of DC personal income tax
Unexpired official documentation of financial assistance from the DC Government including TANF, Medicaid, SCHIP, SSI, housing assistance, or other DC governmental programs
Certified copy of DC Tax Form-D40 (this must be certified by the DC office of Tax and Revenue)
Official military housing orders
Proof that the child is a ward of the District of Columbia
Embassy letter, issued within the last twelve (12) months

Two (2) of the following are acceptable:

Unexpired DC motor vehicle registration
Unexpired lease with proof of payment within the 2 months preceding the school's review of residency documents
Unexpired DC driver's license or non-driver ID
Utility bill with proof of payment within the 2 months preceding the school's review of residency documents

A copy of your responses will be emailed to the addresses you provided

Upload a Scanned Copy of your Residency Documents.

Browse Files

OR Take a CLEAR Photo of your Proof of Residency Documents

Capital Village Public Charter School School Enrollment Form

Special Education

Medication

Parent/ Legal Guardian #1

Parent/ Legal Guardian #2

Emergency Contacts

EMERGENCY CONTACT #2

EMERGENCY CONTACT #3

FOOD ALLERGIES/ADDITIONAL INFORMATION

PHOTO/VIDEO RELEASE

Enrollment

PARENT/GUARDIAN SIGNATURE

PARENT/GUARDIAN SIGNATURE

ANTI-DISCRIMINATION STATEMENT

THANK YOU!