Editing previous response:

Please fix the highlighted areas below before submitting.

SCA Intent to Enroll Form 2026-27

Dear potential Synergy Charter Academy ("Elementary Charter School") parents/guardians:

This form may be used to support Synergy Charter Academy's request for facilities pursuant to Proposition 39 (California Education Code section 47614). By submitting this form, you are indicating that you are meaningfully interested in enrolling your child in a TK (transitional kindergarten) - 5th grade class in Synergy Charter Academy's classroom-based program during the 2026-27 school year. Thank you very much for your support and cooperation!

Please fill out one form for EACH student.

Student Information

Student's First Name:*

Answer required for "Student's First Name:"

Student's Middle Name:

Answer required for "Student's Middle Name:"

Student's Last Name:*

Answer required for "Student's Last Name:"

Grade Level in 2026-27:*

Answer required for "Grade Level in 2026-27:"

Student's Home Address (including zip code):

Street Address

Answer required for "Street Address"

City

Answer required for "City"

Zip Code*

Answer required for "Zip Code"

Home Phone:

Number Required

Student's Date of Birth:*

Answer required for "Student's Date of Birth:"

Does this student currently attend Synergy Charter Academy ("Charter School")?

Answer required for "Does this student currently attend Synergy Charter Academy (\"Charter School\")?"

Yes

Is this child a resident of Los Angeles Unified School District ("LAUSD")?

Answer required for "Is this child a resident of Los Angeles Unified School District (\"LAUSD\")?"

Yes

If yes, please list the name of the LAUSD School this student would otherwise attend:

Answer required for "If yes, please list the name of the LAUSD School this student would otherwise attend:"

Parent/Legal Guardian Name:*

Last, First, Middle

Answer required for "Parent/Legal Guardian Name:"

Home Address

Street Address

Answer required for "Street Address"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Home Phone:*

Number Required

Email:*

Answer required for "Email:"

By signing below, I am indicating that I am meaningfully interested in enrolling or re-enrolling (as applicable) the above named child in Charter School for the 2026-27 school year. I understand that signing this form does not guarantee enrollment in the Charter School. I further understand that this information will be disclosed to the LAUSD to support Synergy Charter Academy’s request for facilities under Proposition 39.

Signature of Parent/Legal Guardian*

Signature Required

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"