Enrollment Form

Eastlake High School Enrollment Request Form
Student's Name*

First NameLast Name
Gender*
Student's Date of Birth*

MonthDayYear
Date
Parent/Guardian Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applying for School Year*
Grade Level*
What school is student currently attending*
District of Current School*
Student's School of Residence (Neighborhood School)*
What is your reason for leaving your current school and requesting Choice Open Enrollment at this school?*

Choice school offers better education/environmentMoved, want to continue attending current schoolChoice school closer to parent/guardian's workMore variety/better sport or extracurricular activitiesStudent's current friends/peers attend cjhoice schoolOther
If siblings are currently enrolled at the requested school, please list name(s) and grade(s).
Are you a resident of District 11?*

YesNo
Has student ever been expelled?*
If yes, provide school name, district, and date (mo/yr)
Enrollment in charter schools is available to all students, including students with disabilities, and information about disabilities will not be requested until a student has been admitted and enrolled in a charter school. For questions regarding the admission and enrollment of students with disabilities in charter schools, you may contact Dr. Brandon Comfort, Executive Director of School Leadership for D11 at 719-520-2119 or Cassandra Berry, Principal at 719-300-8947.

I understand and accept the following conditions if this application request is granted:
1. This approved Choice Open Enrollment application will be valid for attendance at the requested school throughout the grades served by the school level. I must reapply for Choice Open Enrollment to the next academic level. My approved Choice Open Enrollment for one level (e.g. elementary, middle, or high) does not guarantee me an approved Choice Open Enrollment at the next level.
2. Approval of this request is based upon the space available in the receiving school.
3. I understand that transportation to and from school will be my responsibility. District transportation is not provided.
4. The District’s decision as to whether to accept my child’s enrollment is dependent upon my truthful response to all questions asked herein. Therefore, if my child is granted permission to enroll in the District, it shall be on a conditional basis, and in the event that the District should subsequently determine that one or more answers provided were untruthful, this conditional admission may be revoked by the district at its sole discretion.
5. Colorado Springs School District 11 has the right to deny admission to any student that has been expelled from this or any other district in the last 12 months, or who has been expelled as a habitually disruptive student or for a serious violation necessitating mandatory expulsion (C.R.S. 22-33-106(1) (c.5) and (d)); or the student demonstrated behavior during the preceding 12 months that was detrimental to the welfare or safety of other pupils or school personnel.
School District 11 is committed to a policy of nondiscrimination in relation to disability, race, creed, color, sex, sexual orientation, transgender status, gender identity, gender expression, national origin, religion, ancestry, age, and protected activity. Any harassment/discrimination of students and/or staff, based on the aforementioned protected areas, will not be tolerated and must be brought to the immediate attention of the school principal, D11 administrator/supervisor, or D11 Nondiscrimination Compliance Coordinator.

I understand and accept the conditions listed above:
Signature*

Clear
Today's Date*

MonthDayYear
Date
Should be Empty:

Eastlake High School Enrollment Request Form