Student Application & Referral

(Do not leave any questions unanswered)

Please complete all information on all pages and provide all attachments requested. The submission of an application/referral to CAP does not guarantee enrollment in the program. All submissions are subject to review and all candidates must complete an interview with the CAP administration prior to enrollment. All parents/guardians are expected to read the student contract with their children prior to signing the document. Once enrolled, an annual registration fee of $50.00 per family will be assessed. Payment in full must be made prior to student's first day of attendance.

This section MUST BE COMPLETED by the referring organization or agency.

STUDENT INFORMATION:

Gender *
Ethnicity *
Suspended or Expelled? *
In School Suspension? *
Receiving Special Education Services? *
On Probation? *

ALTERNATE CONTACT INFORMATION:

SOCIAL WORKER INFORMATION:

Does the student have a social worker?

AID INFORMATION:

Is the student receiving free or reduced lunch cost? *
Is the student a resident of public housing? *
Is the student benefiting from food stamps? *

EMERGENCY INFORMATION:

REQUIRED DOCUMENTS:

The following items MUST be included with the application:

Make a copy of the student's latest report card and upload the file below.

Choose File

Download the student health insurance form HERE, fill in the information, sign and upload below.

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Download the alternate pickup form HERE, fill in the information, sign and upload below.

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Download the liability and consent form HERE, fill in the information, sign and upload below.

Choose File

Download the student contract HERE, fill in the information, sign and upload below.

Choose File
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