Youngstown Enrollment Form

The Academy for Urban Scholars School is a community school established under Chapter 3314 of the Revised Code. The school is a public school and students enrolled in and attending the school arer equired to pass all state mandated assessments and complete all other graduation requirements as prescribed by Ohio law, In order to receive a High School Diploma from The Academy For Urban Scholars. Students who have been excused from the compulsory attendance law for the purposeof home education as defined by the Administrative Code shall nol onger be excused for that purpose upon their enrolment In a community school. For more informationabout this matter contact the schoof administration or the Ohio Department of Education.

This form asks applicants information about themselves, including their educational and family background. Please click in the desired field and fill the form. After completion sign and submit this form.

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Last Name *

First Name *

Middle Name *

Birth Date * +

Birth City *

Birth State *

Birth Country *

Ethnicity *

Language *

Grade *

Who is the legal parent/guardian? *

Who does the child live with? (for minor children only) *

Guardian must have court custody paperwork (upload here) *

Street Address *

Address Line 2

(Proof of residency must match address)

Gender *

Contact Information

Home Number *

Cell Number *

Alternative Number *

Proof of Age ( Example: Birth Certificate or I.D.) *

Proof of Residency (Example: Utility bill for the past 30 days) *

Homeless *

Yes

No

Do you have an IEP? *

Yes

No

Were you ever retained? *

Yes

No

If you answered "Yes" for homeless you will need to fill out this form.

What Career Pathway would you like to be a part of? *

Healthcare

Construction

Information Technology

What is your primary language? *

How did you hear about the school? *

If Referral who where you referred by? *

What was your previous school district? *

What schools did you previously attend? *

Emergency Contact (can not be a parent) *

City *

State *

Zip Code *

Email *

Signature *

clear

Date * +

By signing this form I acknowledge that I have read this form and agree that all information I entered is accurate.

*This form and any response to it may constitute a public record, and therefore may be available upon request in accordance with Ohio public records law (ORC 149.43).

See the latest School Report Card for Academy for Urban Scholars Youngstown