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2021 Application

SORRY! NO LONGER ACCEPTING SUMMER APPLICATIONS!

Charlotte CSA 2021 Application


Enter Student's Full Name
First Name
Middle Initial/Name
Last Name
Gender
Country
Address Line 1
Address Line 2
City
State
Postal Code
Ethnic Identity
Racial Identity

Program
Select Desired Program
Before & After Care
Fine Arts - First Choice
Fine Arts - Second Choice

Prefix
First Name
Last Name
Suffix
Country
Address Line 1
Address Line 2
City
State
Postal Code
Child Lives With Parent1/Legal Guardian?

Prefix
First Name
Last Name
Country
Address Line 1
Address Line 2
City
State
Postal Code
Child Lives With Parent2/Legal Guardian

First Name
Last Name
Country
Address Line 1
City
State
Postal Code
First Name
Last Name
Country
Address Line 1
City
State
Postal Code
First Name
Last Name
Country
Address Line 1
City
State
Postal Code

Student Has Individualized Education Plan - IEP
If Yes, Please Describe.

Scholarship Application
If I'm applying for a scholarship, I understand my child is required to maintain an 80% attendance rate. I also give permission for my family's income information and child's information to be shared with the appropriate funders.
Image Authorization
I give permission for my child's photo or likeness to be used in media related to the program.
Emergency Medical Authorization
I agree that the agency may authorize a medical practitioner of its choice to provide emergency care if a timely response is needed or if I can not be contacted.
Parent Handbook Agreement
I have received the Parent Handbook.

Enter Full Name

The Family Educational Rights and Privacy Act is a Federal law protecting student education records privacy. Parents have the right to inspect their child's records and request errors be corrected.