Online Enrollment

Student Information

• First:*
• Middle:
• Last:*

• Sex:
• Male Female

• Date of Birth:*
• (MM/DD/YYYY)

• Address Line 1:*
• Address Line 2:

• Zip:*

• Ward:

• Name of Last School Attended:

• Grade Entering SY 12-13*
• Pre-K Kindergarden 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade

Parent/Guardian Information

Mother’s Name/Legal Guardian #1

• First:*
• Middle:
• Last:*

• Home Phone*

• Cell/Work Phone

• Mothers Address is Different than listed above
• Address Line 1:*
• Address Line 2:

• Zip:*
• Email:*

Father’s Name/Legal Guardian #2

• First:
• Middle:
• Last:

• Home Phone

• Cell/Work Phone

• Fathers Address is Different than listed above
• Address Line 1:*
• Address Line 2:

• Zip:*
• Email:

1. Please indicate your campus preference. Community Academy Public Charter School has five campuses, each serving students in a variety of grades from PS–8. You may only submit your application to one campus. (Note that CAPCS cannot guarantee your campus preference selection. Grade levels at each campus are filled on a first come, first-served basis. If there are more applications received than available spaces, CAPCS will conduct an enrollment lottery. If your child is placed on the waitlist after the lottery is conducted, you will be offered the option of attending one of our other campuses or remaining on the waitlist for your preferred campus.)

Preferred Campus
A1 - Benjamin and Gladys Amos Campus - Grades PS-5 A2 - Ernest ”Bunn” and Helene Brooks Amos Campus - Grades PS-K A3 - Ernest & Virginia Amos Campus - Grades PS-8 BC - Wilson and Odessa Butler Campus - Grades PS-5 RC - Addison and Helen Rand Campus - Grades PS-5

2. If your child is waitlisted for the campus you selected and one of the other campuses has an opening, would you like us to send them your application?
Yes
No

3a. Does the enrolling student have a sibling currently at a CAPCS campus?
Yes
No

• If yes, which campus?
• Amos1 Amos2 Amos3 Butler Rand
• Name of Sibling:
• Grade:
• Pre-K Kindergarden 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade

3b. Does the enrolling student have a sibling who is currently applying to a CAPCS campus?
Yes
No

• If yes, which campus?
• Amos1 Amos2 Amos3 Butler Rand
• Name of Sibling:
• Grade:
• Pre-K Kindergarden 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade
• 4. How did you hear about CAPCS?:
• Website Newspaper Ad Radio Family/Friend Flyer Mailing Charter School Fair Television Ad Other

Please Read and Check the Following Requirements for Enrolling in the Dorothy I. Height Community Academy Public Charter School.

Your Application Will NOT be Considered Complete Until You Have Checked Each Applicable Section.

• The student on this application is a resident of the District of Columbia.
• If applying for PS, the student on this application is or will be three years old by September 30, 2012.
• If applying for PK, the student on this application is or will be four years old by September 30, 2012.
• If applying for K, the student on this application is or will be five years old by September 30, 2012.
• ALL GRADES (PS-8): I understand that my student must abide by the Dorothy I. Height Community Academy code of conduct, classroom rules of behavior, and dress code.

• ALL GRADES (PS-8): I understand that this application only applies to the 2012-2013 school year.
• ALL GRADES (PS-8): I understand that I must submit all requested paperwork by the deadlines specified by Dorothy I. Height Community Academy Public Charter School or risk losing my student’s placement at the school.

• I certify that all of the provided information in this application and in accompanying forms is true, accurate, and complete.
• I understand that, if my child is enrolled, my having given false or misleading information or having omitted significant information on this form or any other form or document submitted with this application may result in the loss of enrollment from the school.