AHS Online Intent to Enroll form 2013-2014


Animas High School welcomes you and your student to a unique and rewarding educational experience.
Animas High School is a tuition-free public charter school of choice. AHS is now accepting enrollments for the 2013-14 school year.
If you have specific enrollment questions, please e-mail: enroll@animashighschool.com.
Please complete entire form, all fields are required.


STUDENT INFORMATION

Please note: Fields marked with an “*” are required items.

*Student's District Of Residence as of today's date.

If "Other" Please Specify

Is your child on our legacy list? Yes

Email*

*Child’s Date of Birth (mm/dd/year):

* I am enrolling for admission in the Class of:

Child’s current school:

If "Other" Please Specify

Student Services

If you answer yes to any of the below, please contact Carlin Mallman immediately at 970-259-2797. A copy of your child’s IEP, 504, ESL, ELL, or ALP plan will be needed for review by the ESS team to continue the registration process.

Does your student participate in a gifted and talented program at their last school (an ALP, for Gifted and Talented or Twice Exceptional)?          

Yes

Does your student have a 504 plan?

Yes

Does you student have an ESL or ELL plan? (English as a Second Language, English Language Learner)

Yes

Does your student have a current IEP (IEP = Individual Education Plan for Special Education)

Yes

If yes, check your primary disability code, which is found on page 1 or 2 of the IEP.
Please, check only one:

Significant Limited Intellectual Capacity (SLIC)

Emotional Disability (ED)

Specific Learning Disability (SLD)

Hearing Disability (HD)

Visual Disability (VD)

Physical Disability (PD)
Includes: Attention deficit disorder, Attention deficit hyperactivity disorder, Heart condition, Rheumatic fever, Nephritis, Asthma, Sickle cell anemia, Hemophilia, Epilepsy, Lead poisoning, Leukemia, Diabetes

Speech or Language Impairment (SL)

Deaf/Blind (DB)

Yes

Multiple Disability (MD)

Yes

Autism Spectrum/Asperger’s Syndrome (AU/AS)

Yes

Traumatic Brain Injury (TBI)

Yes

Has you student been diagnosed with AD/HD at any point in their schooling?

Yes

Is your student taking medication for AD/HD?

Yes

If Yes please list medications:

Did you attend a transition meeting set up by your local middle school to assist the transition to high school? Yes

If yes, please give the date of the meeting and the case manager for your child’s IEP, 504, or ALP.

Learning Difficulties

Yes

Health Needs

Yes

Emotional Needs

Yes

Free or Reduced Lunch

Yes

Other. Please describe:

What is the primary language spoken in the home?

If "Other" Please Specify:

Is there anything else you would like us to know about your child?

 

*PARENT/GUARDIAN INFORMATION

Parent 1 Name

Address

City, State, Zip

Home Phone

Alternate Phone (please indicate work, cell or friend)

Email Address

Parent 2 Name

Use Same info as Parent 1?

Address

City, State, Zip

Home Phone

Alternate Phone (please indicate work, cell or friend)

Email Address

Certifications

I/We certify that the information in this application is true and accurate and that any misrepresentation or omission is cause for dismissal at anytime.

Provisional Enrollment:

I/We understand that the information provided on an official transcript and/or IEP documents is necessary in order to determine an appropriate educational service plan. I/We understand that the enrollment of my child may be provisional depending on the information contained in the records. I/We understand that if further discussion is needed about my child's educational fit with the school, Animas High School staff will contact me as soon as possible to schedule a meeting once my child's official record has been obtained.
Inital Here

Parent/Guardian Signature (type in) Date

Animas High School
3206 Main Avenue Durango, CO 81301 
(970)247-2474
info@animashighschool.com

Animas High School follows a non-discriminatory enrollment policy as required by state law (Colorado SB 94-215). Siblings of returning students take priority over non-sibling students. Children of Animas High School employees, Board Members and Founders (as defined in AHS Charter School Application, September, 2007 ) are exempt from the lottery. Forms are stamped with the date as they are received.

It is the policy of Animas H.S. not to discriminate on the basis of sex, race, color, national origin, sexual orientation, marital status, disability, religion or age in admission and access to, or treatment, or employment in its programs or activities as required by Title XI of the Educational Amendments of 1972; Section 504 of the Rehabilitation Act of 1973, Title VI and VII of the Civil Rights Act of 1964, the Age Discriminating Act and their implementing regulations