Editing previous response:

Please fix the highlighted areas below before submitting.

SCA Intent to Enroll Form 2024-25

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 2024-25 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

Student's Middle Name:

Answer Required

Student's Last Name:*

Answer Required

Grade Level in 2024-25:*

Answer Required

Student's Home Address (including zip code):

Street Address

Answer Required

City

Answer Required

Zip Code*

Answer Required

Home Phone:

Number Required

Student's Date of Birth:*

Answer Required

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

Answer Required

Yes

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

Answer Required

Yes

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

Answer Required

Parent/Legal Guardian Name:*

Last, First, Middle

Answer Required

Home Address

Street Address

Answer Required

City

Answer Required

Zip/Postal

Answer Required

Home Phone:*

Number Required

Email:*

Answer Required

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 2024-25 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 Gardian:*

By checking the box below, I acknowledge that the above information is correct.

Answer Required

Check to "Electronically Sign" Intent to Enroll Form

Today's Date:*

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Confirmation Email

Email Required