CSAA Form

Charter Student Admission Application
Charter School Campus Name/ Charter School Name*
School Year*
Student Information
Student Name*

First NameMiddle NameLast NameSuffix
Birth Date*

MonthDayYear
Gender*
Grade Applying For*
Voluntary Information
Social Security Number (SSN)
OR Student Identification Number
*Providing a SSN is voluntary and used to match a student's Unique ID through the Texas Student Data System. If you do not wish to supply the SSN, please supply the SIN. If no SIN exists, one will be generated.
I have another child attending this charter school.

YesNo
This is a child of staff or board member.

YesNo
Primary Guardian Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Contact Phone Number*
Format: (000) 000-0000.
E-mail Address*
example@example.com
*

CERTIFICATION (Required): By checking this box, I certify to the best of my knowledge and belief that the information in this application is complete and accurate, I am the legal guardian of the child listed above, and I understand that any false information, omission, or misrepresentation of facts may result in the rejection of this application or future dismissal of the applicant.
This school does not discriminate on the basis of sex, national origin, ethnicity, religion, disability, or academic or athletic ability. (Esta escuela no discrimina por sexo, origen nacional, etnia, religión, discapacidad, or capacidad académica o atlética.)
School Use Only
Initial Parent Call

Confirmed InformationLeft MessageIdentified Discrepancy
Preliminary Residency Review

Resides in the Dallas CountyDoes Not Reside in the Dallas County
Referral Data
Application Review Status

Ready to be ReviewedLoss of InterestInactivity Close-OutDuplicate (Marked for Deletion)
Source
User Comment(s)
Enrollment Status

Confirmed InterestEnrolledApplication Closed - Loss of InterestApplication Closed - Inactivity Close-OutApplication Closed - Did Not Enroll
Should be Empty:

Charter Student Admission Application

Student Information

Voluntary Information

Primary Guardian Information

School Use Only