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Willie Jeffries School of Excellence Enrollment Application 25-26 School Year
Applications must be signed and submitted for each applying student. *Upon acceptance official records will be requested.
Applicant Information
Student's Name
*
First Name
Middle Name
Last Name
Gender
*
Please Select
Male
Female
Race
*
Please Select
American Indian/Alaska Native
Asian
Black/African American
Native Hawaiian/Other Pacific Islander
White/Caucasian
Other
Ethnicity
*
Please Select
Hispanic/Latino
Not Hispanic/Latino
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@gmail.com
Parent's Primary Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Application Details
Student Grade for SY 25-26
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
Special Services: Does the student have any of the following?
*
Please Select
IEP
504 Plan
ML/ESOL Services
Behavioral Intervention Plan
State Identified Gifted and Talented
Not Applicable
Would you need Before School Care and/or Afterschool Care?
Before School Care (Full Time- 5 days a week)
Before School Care (Part Time-3 or less days a week)
Afterschool Care (Full Time- 5 days a week)
Afterschool Care (Part Time-3 or less days a week)
School History
Students Current School District
*
What school is your student zoned for?
*
Last School Student Attended:
*
Has your student ever been suspended from any school?
*
Please Select
Yes (If yes, please explain below)
No
Please explain below.
Has your student been expelled from any school?
*
Please Select
Yes (If yes, please explain below)
No
Please explain below.
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Enrolling Siblings
Please remember, a separate application must be completed for each child you wish to enroll. This ensures we have accurate information for every student joining us.
Name
First Name
Middle Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Grade Level of Enrolling Sibling for SY 25-26
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Name
First Name
Middle Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Grade Level of Enrolling Sibling for SY 25-26
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Name
First Name
Middle Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Grade Level of Enrolling Sibling for SY 25-26
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Name
First Name
Middle Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Grade Level of Enrolling Sibling for SY 25-26
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Name
First Name
Middle Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Grade Level of Enrolling Sibling for SY 25-26
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
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Referral Program
How did you hear about us?
*
Please Select
Social Media
Website/Google Search
News Paper
Billboard
Community Flyer
Word of Mouth
Community Event
Were you referred to our school by someone?
*
Yes
No
If so, please list the referrer's first and last name
First Name
Last Name
Please the list the referrer's contact number.
Please enter a valid phone number.
Please list the referrer's email address.
example@example.com
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Supporting Documents
After completing the enrollment application, your child's application will be reviewed for acceptance determination. If your child is accepted the following documents will be requested to complete registration and secure your child's seat: Two Proofs of Residence, Long Form Birth Certificate, Immunization Records, and Most Recent Report Card. These documents will be REQUIRED to officially enroll your child. If your child requires special services for Multi-language learners, Gifted and Talented Education, and/or Special Education, we will need those supporting documents during the registration process as well.
Upload Your Student's Report Card
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload Your Student's Current Grades
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload Your Student's Discipline Report
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Guardian Information
Name of Guardian 1 (Must be on birth certificate or legal support document.)
*
First Name
Middle Name
Last Name
Guardian 1 Job/Position
Mobile Number
*
Guardian 1 Relationship to Student
*
Address of Guardian 1
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Guardian 2 (Must be on birth certificate or legal support document.)
First Name
Middle Name
Last Name
Guardian 2 Job/Position
Mobile Number
Guardian 2 Relationship to Student
Address of Guardian 2 (if not the same as above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Full Name of Applying Guardian
*
First Name
Last Name
Applicant's Signature
*
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Once your Enrollment Application has been submitted and the application has been reviewed for class availability, we will contact you regarding the next steps.
Family Education Rights and Privacy Act
In accordance with The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. 1232g; 34 CFR Part 99) students/parents are entitled to review their children's student records. The record, if still in the possession of Willie Jeffries School of Excellence (WJSE) after the student's twenty-fifth birthday, shall be destroyed. If you have any questions regarding this request for individual student information and about our use or disclosure of student information and about our use or disclosure of student information, please contact our office at 803-378-4107.
Non-Discrimination Policy
The Charter Institute of Erskine and the Willie Jeffries School of Excellence does not discriminate based on race, color, national origin, sex, disability, age, religion, or immigrants status in its programs and activities and provides equal access to admission. For questions pertaining to Section 504 or Title IX, please contact our office at (803)-378-4107.
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