Editing previous response:

Please fix the highlighted areas below before submitting.

Application to Enroll Now or for the 2024-2025 School Year

To which school are you applying?*

Answer required for "To which school are you applying?"

Student's First Name*

Answer required for "Student's First Name"

Student's Middle Name

Answer required for "Student's Middle Name"

Student Last Name*

Answer required for "Student Last Name"

Student Date of Birth*

mm/dd/yyyy

Answer required for "Student Date of Birth"

Current Grade*

Answer required for "Current Grade"

Entering Grade*

Answer required for "Entering Grade"

Resident of LAUSD?*

Answer required for "Resident of LAUSD?"

Yes

If yes, what LAUSD school would your child attend?

Answer required for "If yes, what LAUSD school would your child attend?"

Is there a sibling who is currently enrolled at Extera Public School?*

Answer required for "Is there a sibling who is currently enrolled at Extera Public School?"

Yes

If yes, name of sibling

Answer required for "If yes, name of sibling"

Parent First Name*

Answer required for "Parent First Name"

Parent Middle Name

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Parent Last Name*

Answer required for "Parent Last Name"

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

State*

Answer required for "State"

Zip Code*

Answer required for "Zip Code"

Home Phone Number

(555) 555-5555

Answer required for "Home Phone Number"

Cell Phone Number

(555) 555-5555

Answer required for "Cell Phone Number"

Email Address*

Answer required for "Email Address"

Signature*

Answer required for "Signature"

By checking this box and typing my name, I certify that all information on this form is true and correct. I also agree that the checkbox and my name typed below are to be used as my electronic signature, and I am indicating that I am meaningfully interested in enrolling the above named child in Extera Public School for the 2024-2025 School Year. I understand that signing this form does not guarantee enrollment at Extera Public School. I further understand that this information will be disclosed to the Los Angeles Unified School District to support the Extera Public School request for facilities under Proposition 39, and that LAUSD may contact me directly to verify my response.

Enter your name below*

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Confirmation Email

Answer required for "Confirmation Email"