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I.

Application for Admissions

Application Review Checklist:


Please submit the following information
_______________________________________
Eligible Evaluation  Application Fee ..................$10.00
The information gained from the academic  Application for Admissions
history and standardized testing is used to  Copy of Birth Certificate
determine whether a child satisfies the
academic requirements for enrollment at  Copy of Social Security Card
Creative Minds School of Arts. Creative Minds  DH 680 Certificate of
School of Arts admissions process promotes Immunization: original blue card
equal opportunity education and therefore does  DH 3040 Student Health Exam
not discriminate in enrollment or enrollment (Current)
status based on gender, race, socioeconomic  Complete Academic History:
status, political affiliation and academic ability.
copy of current or final report
Acceptance for Admission card and transcript with grades,
When a student is selected for admissions, a standardized test results and
registration packet will be provided. This packet student evaluations from current
will state a deadline within a 15-day period school
requesting the following:  Discipline Report from current
 Tuition to be paid school
 Other enrollment material (i.e. student  Educational Services
photo, emergency information, etc.)
 If in an ESE program, a
 Request for Official Records from
previous school (Must Be Received copy of current IEP or EP
Within 3 Days)  If on a 504 Plan, a copy of
 Course information, extra-curricular professional
questionnaire recommendations
 Important dates to note  Behavioral Plan
 Psycho-social/educational
Further Information: documents (including
Contact: Creative Minds School of Arts Mental Health)
and Technology
Registrar’s Office Submit all requested material to:
1410 East Indian Head Drive Creative Minds School of Arts and
(850) 656-6563- Phone Technology
(850) 656-6564- Fax ATTN: Registrar’s Office
1410 East Indian Head Drive
Tallahassee, FL 32301
An incomplete application WILL NOT
be accepted. Please make sure you
have included all items listed below.

For all students:

Page 2 of 10 FAMU DRS Application for Admission Revised 04/09


****An Incomplete Application WILL NOT Be Accepted***
_____________________
II.Student Information Today’s Date

Grade applying K 1 2 3 6 7 8
for: 4 5

Student’s Legal Name


Last Name First Name Middle Name AKA
Mailing Address

Street Apt# City State Zip

Email Address Home Phone Cell Phone

Physical Address (if different from mailing address)

Street Apt# City State Zip

Email Address Home Phone Cell Phone

Age Date of Birth Place of Birth Sex Male Female

Racial/Ethnic Category White Black Hispanic


American Indian/Alaskan Asian/Pacific Multi-racial
Native Islander
Parent/Legal Guardian #1

Last Name First Relationship Home Phone

Street Address City State Zip

Place of Employment Business Phone Other Phone

E-mail Address

Parent/Legal Guardian #2

Last Name First Relationship Home Phone

Street Address City State Zip

Place of Employment Business Phone Other Phone

E-mail Address

Marital Status of Married Single Divorced Separate


Parent/Guardian(s): d Widowed

Student Lives Parent/Guardian #1 Parent/Guardian #2 Both


With:
Grand Parents Other (please specify)
______________________________

Page 3 Application for Admission Revised 05/19


Emergency Contact Information

___________________________________________________________________________________________________________
Last Name First Relationship
Home Phone

___________________________________________________________________________________________________________
Street Address City State
Zip

___________________________________________________________________________________________________________
Place of Employment Business Phone
Other Phone

___________________________________________________________________________________________________________
E-mail Address

III. Academic History


Student’s Legal Name
Last Name First Name Middle Name Social Security #

Please list the school last attended

Page 4 Application for Admission Revised 05/19


School Name

Street Address City State Zip

Business Phone

Student Discipline Record


At the time of initial application to the Creative Minds School of Arts and Techno, a complete
disciplinary history must be provided. An itemized “Student Discipline Report” from all
school(s) attended within the past 2 year is also required. These reports may be obtained
from the school(s) the student has attended.

1. Is this student currently /has this student ever been suspended from any school? ............
No Yes, explain below.

2. Is this student currently/has this student ever been expelled from any school?.........
No Yes, explain below.

3. Is this student currently in adjudication or has this student ever been arrested?.......... No
Yes, explain below.

4. Has this student ever been subject to juvenile justice actions? .......... No Yes, explain
below.

If yes was answered to ANY of the above, please explain:


__________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________

Educational Services

Please identify your student’s exceptionalities:

1. Is your child currently being evaluated for placement in an exceptional student


education program?.................................................................................................. No Yes
If yes, provide explanation and/or documentation

2. Is your child currently receiving services through an exceptional student education


program? ………. No Yes
If yes, provide a copy of your child’s current Individual Educational Plan (IEP) or
Education Plan.

3. Does your child currently have a 504 Plan?.......................................................... No Yes


If yes, provide a copy of your child’s 504 Plan.

Page 5 Application for Admission Revised 05/19


If yes to any of the above questions, please provide a copy of the initial
evaluation, current IEP or current 504 Plan along with this application.

IV. HOME LANGUAGE SURVEY


Student’s Legal Name

Last Name First Name Middle Name Social Security #

The State of Florida requires identification of language minority students by dominate


language group. All students and/or parents/guardians, native or non-native English
speakers must complete this survey prior to beginning the school registration process.

1. Is a language other that English used in the home? ............................................ No Yes


If yes, specify language ___________________________________________________________________________

2. Does the student have a first language other than English? ............................... No Yes
If yes, specify language ___________________________________________________________________________

3. Does the student most frequently speak a language other than English? ............... No
Yes
If yes, specify language ___________________________________________________________________________

If answers to question 1, 2, and 3 are NO and indicate English only, STOP, and sign and date
below.

If a YES is checked or a language other than English is indicated, please continue and begin
the ELL assessment procedures.

4. Was the student born in another country?............................................................ No Yes


If yes, what country? ______________________________________________________________________________
Date of entry to U.S.______________________ Anticipated date of exit from U.S.____________________

5. Does the student understand English?


…………………………………………………………………….. No Yes
Does the student speak English?
…………………………………………………………………………… No Yes
Does the student write English?
…………………………………………………………………………….. No Yes

6. What is the home country of the student’s Father? ______________________________________________


Does the Father understand English? ................................................................... No Yes
Does the Father speak English? ............................................................................ No Yes

7. What is the home country of the student’s Mother? _____________________________________________

Page 6 Application for Admission Revised 05/19


Does the Mother understand
English?................................................................................................ No Yes
Does the Mother speak English?
……………………………………………………………………………. No Yes

8. Student lives with_____________________________________ Relationship _____________________________

Parent/Guardian #1 Signature Date

Parent/Guardian #2 Signature Date

Page 7 Application for Admission Revised 05/19


Page Left Blank
Intentional

Page 8 Application for Admission Revised 05/19


V. Photo Release
Student’s Legal Name

Last Name First Name Middle Name Social Security #

Specific Consent for USE OF AN INDIVIDUAL PHOTO ON THE SCHOOL’S WEBSITE and in
related Publications

Creative Minds School of Arts will actively update its Web site to provide more information
to parents. To promote some of the activities of the school, we would like to use images of
students that illustrate the diversity and the talents of the school. Photographs of your
daughter/son may be used for this purpose in the school’s website or in related newsletters.
This form gives consent for the use of your son’s/daughter’s schoolwork and photograph on
the school’s website, in the media and for related newsletters as approved by the school’s
administration.

Please read this form carefully before completing and signing. This consent may be
withdrawn at anytime by writing a letter to the Principal/Director. If you have any questions,
please contact the Principal/Director.

Student Details

Full name of student:

Address of student:
Name of person giving
consent:

Address:

Consent

I, _________________________________________________________________________(print name of parent/guardian)

give consent or DO NOT give consent

to use my daughter’s/son’s name, photograph and work in publications and media


presentations as approved by the school’s administration.

Parent/Guardian #1 Signature Date

Parent/Guardian #2 Signature Date

Page 9 Application for Admission Revised 05/19


Student Signature Date

Page 10 Application for Admission Revised 05/19