Academia Avance Enrollment Form

Academia Avance Enrollment Form
Enrollment Term*

Emergency Contact Information
Student Release

In case we are unable to reach you during an emergency, you authorize to contact and, if necessary, release your child to any of the following:
Emergency Contact Name #1 *

First NameLast Name
Relationship to Student*
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name #2

First NameLast Name
Relationship to Student
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name #3

First NameLast Name
Relationship to Student
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School-wide Announcements/Messages from Staff

Who should we contact for messages from staff/faculty such as announcements and individual messages about your child’s behavior, attendance, and academic performance?
Contact Name #1*

First NameLast Name
Preferred Language*

EnglishSpanishOther
Primary Phone Number*
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
Email*
example@example.com
Contact Name #2

First NameLast Name
Preferred Language

EnglishSpanishOther
Primary Phone Number
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
Email
example@example.com
*The information that I have given above is correct to the best of my knowledge.
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date

Academia Avance Application Attestation
I have filled out this application completely and accurately. I understand that any omissions or misstatements could result in the rejection of the application and loss of placement in our lottery system. I verify that the information in this application is true and correct to the best of my knowledge.
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
You may contact the school at any time using the following details:
Academia Avance Front Office
115 N Avenue 53
P.O. Box 42095
Los Angeles, CA 90042
Phone: 323-230-7270
Fax: 213-652-0994

Publication Release Form 2024-2025
I hereby grant permission to allow for my daughter/son, Student Name* to be photographed. I fully understand that these pictures may be used for a variety of publications; such as community newspapers, school slide/picture presentations, brochures, Official School Social Media internet publications or other similar school publications. I also give permission for his/her name to be printed along with the photographs.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date

Avance Uniform Guidelines 2024-2025
Making a good impression upon our community will help foster productive relationships with our community partners and help each student represent Avance in the classroom and future networking opportunities. Dressing for college and career readiness will allow our students to:
- Establish a professional appearance
- Establish themselves as positive figures in the community
- Provide students a sense of pride
- Direct focus to performance
Therefore, students of Academia Avance are required to wear a uniform. Please read carefully as adjustments and clarifications from previous years are provided below. Complete uniform guidelines can be found online at www.academiaavance.org .

Daily Uniform
1. Burgundy Avance Polo (middle school) or Navy Blue (high school) (white undershirt).
2. Khaki Pants/ Shorts; shorts NO shorter than 2” above the knees and no lower than 2” below the knees
3. Navy blue blazer, crew neck sweatshirt, cardigan sweater, track jacket with Avance Logo.
4. Shoes with shoelaces (slip on sandals are not allowed)
5. College OR Avance Hooded Sweaters/jackets.
Spirit Day
1. Any Academia Avance Extracurricular Activities or Club T-Shirts.
2. College T-shirt, Polo, or Crew Neck sweatshirt.
3. Shorts/Jeans: shorts no shorter than 2” above the knees and no lower than 2” below the knees.
Free Dress (Only given as incentives)
1. No inappropriate logos on clothing.
2. Clothes must fit appropriately on students..
3. Shorts/Jeans: no shorter than 2” above the knees and no lower than 2” below the knees. Pants must fit the student's size.
4. Dresses: no shorter than 2” above the knees.
5. Avance OR College hooded sweaters are the only hoodies allowed.
NOT ACCEPTED DAILY
- Sandals or open toe shoes
- More than 1 facial piercings- No ear stretchers or plugs
- Visible tattoos- Any visible tattoos must be covered at all times
- Torn attire, Leggings or fishnet stockings
- Writing OR graffiti on backpacks
**Avance students must remove all facial piercings when attending a community or special event.
I Parent/Guardian Name* understand that my student Student Name *must comply with the uniform guidelines set forth by Academia Avance. Failure to do so will result in disciplinary action in compliance with Academia Avance Charter & California Code of Education
Parent/Guardian Signature*

Clear
Student Signature*

Clear
Date*

MonthDayYear
Date
School Uniforms Purchased at Academia Avance. For more information, call us at: (323) 230-7270.

Academia Avance Student/Parent/Guardian Pledge
Student Academic Pledge:

I recognize that going to school is very important. I am aware that my parents and the school expect me to be a hard worker at Academia Avance so that I may be successful in college. I understand that during the academic year I will be responsible for:
- Coming to school everyday on time, ready to learn, and prepared with all supplies.
- Reading at least 30 minutes everyday beyond the assigned homework.
- Taking care of my books and other materials that the school has assigned to me.
- Completing all assignments to the best of my ability and turning them in on time.
- Upholding the integrity of all my work, never succumbing to plagiarism, forgery, or any other form of cheating.
- Communicating with my teachers in a timely manner when there are questions about my work and/or progress.
- Obeying the school’s Code of Conduct and Code of Respect.
- Maintaining respectful relationships with my peers and resolving conflicts effectively.
- Being trustworthy and faithful in delivering school communication to my parents.
- Following directions given by the administration and staff.
- Demonstrating respect and appreciation for my community by completing at least 20 hours of community service.
- Participate in the Avance Restorative Justice practices to resolve issues with other students.
Parent/Guardian Academic Pledge:

I understand that my child’s studies are of extreme importance and that my participation in activities at Academia Avance are a critical component in my child’s academic success. I will be responsible for:
- Ensuring that my child is at school on time
- Providing my child with a clean uniform every day.
- Ensuring he/she obeys the uniform policy.
- Enforcing the school's Code of Conduct with my child providing the appropriate consequences at home for
  non-compliance.
- Providing a quiet place for my child to concentrate on his/her studies.
- Ensuring that my child completes his/her homework and/or projects on time by reinforcing good study habits.
- Ensuring that my child reads material other than school assignments each night for at least 30 minutes.
- Understanding that my child will participate with all learners at Academia Avance.
- Enrolling my child in academic enrichment programs as advised by the school.
- Attending all parent workshops during the school year.
- Attending all scheduled parent/teacher conferences.
- Granting my child permission to participate in all school field trips and off-campus activities.
- Understanding that my child will need to make up all missing assignments due to any absences.
- Maintaining ongoing, scheduled communication with my child’s teachers.
- Respecting the classroom environment when visiting my child’s classrooms.
- Supporting the Avance Restorative Justice practices to resolve issues that may involve my student.
- Following the procedures proscribed in the Avance Uniform Complaint & Procedures (UCP) policy to resolve concerns with the school, available here: www.AcademiaAvance.org/ucp
My child and I have discussed these responsibilities and the Code of Conduct. In consideration of the unique opportunities offered by Academia Avance, we voluntarily agree to fulfill all of the commitments listed above.
Parent/Guardian Signature*

Clear
Student Signature*

Clear
Date*

MonthDayYear
Date

Household Financial Information

Academia Avance is subject to federal & state funds that require submission of the information requested below. The information you provide is kept strictly confidential.
Please indicate:
Household size*
Annual Income (12 months)*
Student Name*

First NameLast Name
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date

Authorization for Emergency Medical Treatment
The undersigned, as parent/legal guardian of (student name) Student Name a minor, hereby authorizes the principal or designee, into whose care the student has been entrusted, to consent to any X-ray examination, anesthetic, medical or surgical diagnosis, treatment, and /or hospital care to be rendered to the student upon the advice of any licensed physician and/or dentist. It is understood that this authorization is given in advance of any required diagnosis, treatment or hospital care and provides authority and power to Academia Avance to give specific consent to any and all such diagnosis, treatment, or hospital care with a licensed physician or dentist may deem necessary. This authorization is given in accordance with Section 49407 of the California Education Code, and shall remain effective until revoked in writing and delivered to the District. I understand that the District, its officers and its employees assume no liability of any nature in relation to the transportation of the student. I further understand that all costs of paramedic transportation, hospitalization and any examination, X-ray or treatment provided in relation to this authorization shall be my sole responsibility as the student’s parent/guardian.

Health Alerts: Please list any medical condition which restricts physical activity or requires special attention. Include conditions such as asthma and allergies such as peanut and bee stings. If none, please indicate “none".*

	Name of Medication(s)
My child is allergic to the following medication:
My child currently takes the following medication:

Does the student have health insurance?*

YesNo
If yes,

ID number

Medi-Cal/Health Family ID number

	ID number
Medi-Cal/Health Family ID number

	Name/Group number
Private Health Insurance Name
Private Health Insurance Group Number
Name of Doctor/Medical Office

*I certify that I have read and understood this form and do hereby give my authorization for emergency medical treatment, and that all of the information I have provided on this form is true and correct.*
Parent/Legal Guardian Signature*

Clear
Date*

MonthDayYear
Date

Avance Behavior Plan
The Avance Behavior Plan was created to meet three goals:

1. To establish clear standards for a respectful, safe, and productive learning community.
2. To ensure that all students benefit from a high level of support in learning to meet these standards.
3. To ensure that students receive equitable and consistent consequences when they do not meet these standards.

The plan has 5 tiered levels of behaviors and consequences. Complete Behavior guidelines and matrix can be found online at www.academiaavance.org.

The schools follow the practices of Restorative Justice to find resolution for issues with students. An overview is provided in this guide: http://fromdiaperstodiamonds.com/wp-content/uploads/2015/06/Restorative-Practice-Parent-Booklet-Real-Justice.pdf

**In addition, positive programs to support and motivate students will accompany the plan.**

Cell Phone/ Smart Device Usage

In order to maintain a focused academic environment and support all student learning, students at the Middle School, must turn in cell phones and smart devices at the beginning of the day. Devices are returned to students at the end of the day. High School students are not allowed to use personal cell phones in all classes or during passing periods. During lunch time, students will be allowed to use their cell phones with the following conditions:
- No negative pictures/posts/texts or communication of:
  - Themselves
  - Other students
  - Faculty and Staff
Defamation of Academia Avance Charter School will not be tolerated and will result in loss of cell phone privileges.

If a student fails to abide by this policy, the cell phone will be forfeited and if it is a continuous problem a meeting with the parent and student will be held to determine disciplinary action. Students are NOT allowed to use Academia Avance’s Internet/ WIFI for personal use. We ask that parents/guardians not contact students during class/instructional time.

**Academia Avance is not responsible for loss, damage or theft of any electronic device. If lost, there will be no compensation.**

*My signature below indicates that I have read and accepted the Avance Behavior Plan. *
Parent/Guardian Signature*

Clear
Student Signature*

Clear
Date*

MonthDayYear
Date

IT Use Policy and User Agreement
Academia Avance encourages students (user) to use its information technology resources, including the Avance network, Avance intranet (inside Avance), Internet and all electronic equipment and hardware in the Academia Avance IT system in a creative and productive way. However, there are limitations on how these resources may be used. With this in mind, Academia Avance wishes to ensure that all users understand the following:

Account Information & Privacy
1. Non-privacy of communications, messages, files and sites: Users should have no expectation of privacy of their communications, messages, emails, chats, attachments, sites, and files made transmitted, received, or stored on or through Avance IT system on all school sites. This understanding also pertains to all communications, messages, emails, chats, attachments, sites, and files using Avance remote systems on all personal devices used for the benefit of Avance. This understanding also includes all communications, messages, emails, chats, attachments, sites, and files transmitted, received, or stored using remote access into Avance IT systems. Even when computer resources may be password-protected, there is no special confidentiality or privacy on communications, messages, or files. The user’s signature on this User Agreement indicates the user’s agreement to this provision and the following understandings.
2. With no notice to the user, network administrators routinely monitor and make backup copies of certain Avance IT system resources and databases, including but not limited to the thin clients, network use, communication systems, E-mail messages, chats, google app sites, Avance tools, internet sites log, individual and group MAC addresses, and individual and group IP addresses to assure the optimum functionality of the system and to protect against violations of use
  pursuant to this agreement, and that they have the ability to view the user’s files, messages, or other communications.
3. With no notice to the user, network administrators may review the user’s files, messages, chats, or other communications and, if misuse of the IT system resources is discovered, record or otherwise use them as a basis for disciplinary action, up to and including termination, suspension, expulsions, or use them as evidence in litigation. Misuse of Avance provided resources or misuse during remote access to Avance systems using devices used for the benefit of Avance may also result in prosecution under applicable federal and state laws and/or required reimbursement to the Avance for damages.
4. Avance may be subject to subpoenas or other court orders requiring the recording and/or release of the user’s files, messages, or other communications, and that the Avance may comply with those subpoenas or court orders under California State and Federal Laws.
5. All data contained within Avance systems is the property of Academia Avance Charter School and its corresponding district.
6. The network administrators may impose restrictions to ensure maximum performance and fairness to all users. These restrictions may include, but are not limited to disk quotas, time restrictions, and concurrent connections.
7. Avance is not responsible for loss of user files, communications, emails, attachments, and chat histories. Each user is responsible for backing up his or her files separate from the server backup.
8. Users should be aware of any policy changes or updates. Users can check the account information section on the Avance website (www.academiavance.org) for additional or updated information.
9. Accounts are available to all employees and students while he or she is employed with Avance subject to certain restrictions deemed appropriate and necessary by network administrators pursuant to this agreement.
Security Guidelines
1. Security is understood to include the control of access to information, protection of information against unauthorized modification, and protection of systems against denial of service.
2. Users are responsible for understanding security guidelines and maintaining the security of the systems they are using. Therefore, users are responsible for information system activity conducted under their username and password.
3. All users must use only their assigned username and password when using Avance resources. Under no circumstances should a user give out his/her password or allow anyone else to use your account. Users who require access to another user’s files should see the network administrator. If someone else uses your account, it will be disabled without notice. If a user grants permission to another user to use their account, the granting user violates Avance IT use agreement and will be responsible for all violations of use subject to reasonable limitations pursuant to this agreement and California and Federal laws.
4. Users are to report any observed violations of or attempts to violate Avance security to the network administrator.
Non-Avance Equipment and Use
1. Network access via non-Avance workstations and equipment is permitted with written authorization from Avance IT administrators. Remote access to Avance networks are subject to restrictions and limitations based on Avance IT administrators’ discretion.
2. Network access via non-Avance workstations and equipment, i.e. personal laptops, PDA, cell phones, etc., is not permitted without clearance from the Avance IT administrators
3. Communications, files, and other information stored on non-Avance equipment used for the benefit of Avance such as laptops, PDA’s, and other devices is private to the user and is protected under California and Federal privacy laws EXCEPT in the following instances.
  1. Communications, emails, chats, files, attachments have been transmitted or stored by the user via Avance networks either through Google Applications emails or chat or through authorized remote access to the Avance network from non-Avance equipment.
  2. Communications, emails, chats, files, attachments, and other media is under official criminal investigation by legal authorities in which non-Avance equipment and its contents may be subject for use as evidence.
Users Must Be Lawful and Inoffensive
1. Users of Avance systems must adhere to the Avance Community Standards.
2. Users of Avance systems must not be false, unlawful, offensive, or disruptive.
3. Users of Avance systems must not infringe on any copyrighted material, this includes streaming, downloading, and distributing of unlawfully obtained copyrighted material.
Policy Violations
1. Avance will review alleged violations of policy and procedures on a case-by-case basis. Violations of the policy will result in referral for disciplinary action as appropriate.
Criminal Penalties
1. Unauthorized access or use of any Avance resource may subject offenders to criminal prosecution under federal law or California state law.
By signing below, I agree to abide by the requirements set forth above for the types of access I have to Avance IT resources, both on school sites and through remote access of Avance systems. I specifically agree to the monitoring of communications and non-privacy provisions set forth above. I understand that any violation of this agreement may result in loss of access or services, disciplinary action, termination of employment, or prosecution under federal and state laws.

Signatures (REQUIRED FOR SCHOOL CHROMEBOOK USE)
If the user is a student and is under 18 years of age, he or she must have his or her parents or guardians read and sign this agreement. Avance cannot provide access to any student who, if 18 or older, fails to sign and submit this agreement to Avance as directed or, if less than 18, does not return this agreement as directed with the signatures of the students and his/her
parents or guardians. Upon reviewing, signing, and returning this agreement, the student will be given the opportunity to use the
Avance network.
Student Signature*

Clear
Student Name*

First NameLast Name
Parent/Guardian Signature*

Clear
Parent/Guardian Name*

First NameLast Name
Date*

MonthDayYear
Date

Avance Food Service Summary
Academia Avance is proud to be part of the
Universal FREE Meals Program

California’s Universal Meals Program is designed to build on the foundations of the Federal National School Lunch Program (NSLP) and School Breakfast Program (SBP). All public schools in California must include both a nutritiously adequate breakfast and lunch for all children, each school day, at no cost to students.

Academia Avance is pleased to be able to offer FREE breakfast and lunch to ALL students regardless of family income. We have partnered with food vendor, Unity Meals, to provide our students with healthy, appealing and tasty food options. Our school meals provide a well-balanced diet of healthy proteins, whole grains, a variety of dairy, and fresh fruits and vegetables.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date

Authorization to Participate in School Counseling Services
Academia Avance is pleased to announce that we will be offering counseling services to our students. Parents/guardians or school staff may refer students for counseling, or students may request counseling. All counseling is voluntary. We will be providing Academic, Career, and/or Personal and Behavioral Counseling (CA Ed. Code 49600). We are committed to helping our students achieve greater success in their academics, social development, emotional growth, and career aspirations.

The counseling relationship requires an atmosphere of trust and confidence. Confidentiality is fundamental in the counselor-student relationship. We support the students’ rights to privacy, and therefore, information received during counseling sessions will be kept confidential.

This Confidentiality Agreement is designed to advise you of the limits of confidentiality between student and counselor. State law and professional ethics require counselors to maintain confidentiality, with the exception of the following situations or circumstances:

1. If there is suspected child abuse, elder abuse, or dependent adult abuse.
2. A situation in which a serious threat to a reasonably well-identified victim is communicated to the counselor.
3. When a threat to injure or kill oneself is communicated to the counselor.
4. Court order disclosure. If counseling records are court ordered, the counselor will attempt to contact you first.
5. Consultation with other school professionals/education staff, with regard to treatment support of the student and/or family.
6.Referral to an outside agency, with the written consent of the parent/legal guardian.
By signing the bottom of the form, you, the parent/legal guardian, are indicating that you understand any information shared with the counselor will remain confidential with the exceptions mentioned above. It is your right to accept, refuse, and/or stop these services at any time.*

I accept the servicesI decline the services
Student Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone Number*
Please enter a valid phone number.
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
**If you have any specific questions or need further assistance, please contact the front office. For Middle School: (323) 230-7210. For High School: (323) 230-7270.**

Information Packet Checklist
YOUR ENROLLMENT WILL NOT BE CONSIDERED COMPLETE UNTIL YOU TURN IN THE FOLLOWING DOCUMENTS, WHICH YOU MAY UPLOAD IN THIS FORM, BRING TO THE SCHOOL, OR SEND TO ENROLL@ACADEMIAAVANCE.COM

Documents to be turned in:
- Birth Certificate
- IEP (if applicable)
- Immunization Record (*incoming 7th graders must have TDap)
- Most Recent Report Card
- Court Guardianship (if applicable)
- Transcript (Grades 10-12)
Birth Certificate

Cancelof
IEP (if applicable) 

Cancelof
Immunization Record (*Incoming 7th graders must have TDap)

Cancelof
Most Recent Report Card

Cancelof
Court Guardianship (if applicable)

Cancelof
Transcript (Grades 10-12)

Cancelof

Inscription Receipt
Student Name*

First NameLast Name
Student Grade 2024-2025*
By signing this form, Academia Avance acknowledges that you have fully completed and turned in your application.

This form is proof of receipt of application. It does NOT indicate that the student has been accepted to Academia Avance. You will be contacted by the school with notification of acceptance following Inscription Day.
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Avance Administrator Signature

Clear
For Office Use ONLY
**We are an equal opportunity employer.**
Should be Empty:

	Previous Schools/ Programs Attended	City and State	Dates Attended	Grade Levels	LAUSD School?
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	Name of Sibling	Age	Grade Level	School of Attendance	Applying to Academia Avance?
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Academia Avance Enrollment Form

Student Information

Race and Ethnicity

Student Education History

Special Services

Family Information

Parent(s)/Guardian(s) Information

Emergency Contact Information

Home Language Survey

Academia Avance Application Attestation

Publication Release Form 2024-2025

Avance Uniform Guidelines 2024-2025

Academia Avance Student/Parent/Guardian Pledge

Household Financial Information

Authorization for Emergency Medical Treatment

Avance Behavior Plan

IT Use Policy and User Agreement

Avance Food Service Summary

Authorization to Participate in School Counseling Services

Information Packet Checklist

Inscription Receipt

	Types of Services Received (e.g. speech therapy, special education, etc.)	School, Program, or Agency that provided services	Date Services Began & Duration
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