Call Us at 800-297-2119Careers Policy Sheet

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STUDENT INFORMATION/DEMOGRAPHICS

/ /

Current Physical Address:

Current Mailing Address:

SECTION TWO - PARENT/GUARDIAN INFORMATION

Current Physical Address:

PRIMARY HEADS OF HOUSEHOLD (With whom does the student reside?)

Primary Household DataPrimary Head of Household 1Primary Head of Household 2

SECONDARY HEAD(S) OF HOUSEHOLD

SECTION THREE - SPECIAL NEEDS / ETHNICITY / HEALTH INFO

HEALTH INFORMATION

Medical information is confidential and will be shared with personnel on a need to know basis.

SPECIAL NEEDS INFORMATION


Part A: Ethnicity
(choose only one)


Part A refers to ethnicity, not race. No matter which box you selected above, please continue to answer
Part B (below) by marking one or more boxes to indicate what you consider your students race to be.
Part B: Race
(Choose one or more)
When choosing more than one, enter % for each ethnicity
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian / Other Pacific Islander
White

SECTION FOUR - PREVIOUS SCHOOL INFORMATION

Enter any previous schools attended below

SECTION FIVE - ADDITIONAL EMERGENCY CONTACT INFORMATION (NOT PARENTS)

Name Relationship Type Work Phone Cell Phone Home Phone
Doctor If a medical emergency exists, the school will take appropriate action on behalf of the child. The family will assume all medical costs.

OTHER SIBLINGS LIVING AT HOME

Name Gender Birthdate School Grade

SECTION SIX

Are you currently attending school?
Are you planning to go back to the last school district attended?
Do you have a GED?
Do you have a high school diploma?
When do you plan on working in your classes?



SECTION SEVEN - DISCLAIMERS

Disclaimer:

Michigan State Required Testing
It is mandatory that students in our program participate in state and federal testing during required dates. Please note that families are also responsible for travel costs associated with commuting to our physical building location(s) for orientation(s), state and federal testing purposes, and any other required activity. Families should consider travel limitations before enrolling at our school.

***NOTE*** The school must have a copy of the order to deny release/contact to a parent.

Please Read: Presenting false information, false records or falsifying records is an offense punishable by federal and state law. By signing below, you attest that all information provided on this form is true and accurate.
Press/Video Release

Step-Up Schools has my permission to use photographs and/or videos of my child to show school activities to the public. I understand that the personally identifiable information may be used at the discretion of the media, involving no financial compensation to Step-Up Schools , the student, or the family of the student. The final edited pictures and sounds may be shown without restriction, including radio and television broadcast, cablecast, printed publication, website and any other social media. I understand that I have the right to deny consent to the release of the photographs and/or information specified above, by refusing to sign this. If you consent, please sign here:
If permission is denied, please write “DENIED” on the signature line
Please Read: Presenting false information, false records or falsifying records is an offense punishable by federal and state law. By signing below, you attest that all information provided on this form is true and accurate.

SECTION EIGHT - POLICY SHEET

As a Step Up Student I understand:
FOR OFFICE USE ONLY

ONLINE LEARNER READINESS RUBRIC

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FILE UPLOADS

Required Documents:

Birth Certificate

Picture I.D.

Proof of Residency (Utility Bill, Lease Agreement)

Shot/Immunization Record

All High School Transcripts

Upload Your Documents

To help expedite your application process, we give you the option to upload digital versions of any or all of these documents onto our secure, encrypted servers.

Once your files are received, they will be removed from the site and stored in our office.

Depending on the district, you may be asked for other documents.

To upload your files, check the boxes above to indicate which documents you are including then select the files on your computer in the popup window after clicking 'Upload Your Documents'

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