Lumos Arts Academy Initial Application
Are you a new or returning student to Lumos?
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Grade you are applying for
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What school year are you applying for?
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Student's Legal Name
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First Name
Middle Name
Last Name
Date Of Birth
/
Month
/
Day
Year
Date
Gender
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Male
Female
Racial/Ethnic Background
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Primary Contact Name
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First Name
Last Name
Relationship to Student:
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Mother
Father
Legal Guardian
Other
Cell Number
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-
Area Code
Phone Number
Work Number
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Area Code
Phone Number
Email
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example@example.com
Primary Contact's Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Does the student have a secondary address?
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Yes
No
Secondary Contact Name
First Name
Last Name
Relationship to Student
Mother
Father
Legal Guardian
Other
Cell Number
-
Area Code
Phone Number
Work Number
-
Area Code
Phone Number
Email
example@example.com
Secondary Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is the primary language spoken by the student?
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Last School Attended
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City and State
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Last school year attended
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Does your student currently have or have they ever had an IEP or 504?
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IEP
504
No
What is the primary eligibility on the IEP?
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What is the secondary eligibility if applicable?
What is the name of the school where the IEP/504 was obtained?
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What is the City and State of the IEP?
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Is your student's IEP/504 current?
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Yes
No
Does your student have a current evaluation (called an MET)?
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Yes
No
Please upload documents for IEP/504
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Please upload your student's evaluation (MET)
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Please upload a copy of your student's immunization record or waiver
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Please upload your child's birth certificate
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of
Please upload proof of residency
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of
Please upload most recent report card/progress report
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Please upload attendance record from prior/current school
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of
Please upload discipline record from current/prior school
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of
Please tell us about your student's artistic background and areas of interest in the Arts. Be as detailed as possible, including all artist accomplishments.
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Please tell us about any community service work your student has done.
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Is there any additional information that you would like to provide about your student?
Would you be interested in volunteering for the school?
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Yes
No
What kind of volunteer work would you like to do?
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Helping with Showcase
Helping with Musical/Play
Helping in the classroom
Other
Would you be interested in carpooling with other parents?
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Yes
No
What are your major cross streets?
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How did you hear about us?
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Online Search
Friend/Family
Social Media
Other
Please Provide family/friend name
Parent/Legal Guardian/Student over 18 signature
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Please Print Name
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Submit
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