HighTech Los Angeles Charter High School

17111 Victory Blvd. Van Nuys, CA 91406. Phone: (818) 609-2640 ... The charter school disseminates outreach materials to its charter community containing the ...
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HighTech Los Angeles Charter High School Student Application for Lottery: School Year 2017 – 2018 17111 Victory Blvd. Van Nuys, CA 91406 Phone: (818) 609-2640 Fax: (818) 881-1754 www.ht-la.org

Before submitting student application please note:  Applications will be accepted beginning Friday, September 16th, 2016 through the deadline Friday, February 10th, 2017 for 9th grade students. Applications received after Friday, February 10th, 2017 will not be entered in the lottery, and will be placed at the bottom of the waitlist. A public admissions lottery will be held at 4:30 pm on Wednesday, February 22nd, 2017 in the Great Room at HTLA.  Applications will be accepted beginning Friday, September 16th, 2016 through the deadline Friday, July 21st, 2017 for 10th, 11th, and 12th grade students. Applications received after Friday, July 21st, 2017 will not be entered in the lottery, and will be placed at the bottom of the waitlist. A public admissions lottery will be held at 9:00 am on Thursday, July 27th, 2017 in the Great Room at HTLA.  Results of the public lottery will be emailed and mailed within 5 working days of the lottery, and will be posted on the HTLA Website (www.ht-la.org) Results will not be given over the phone.  Preference will be given to students in the LAUSD residential area. Students outside of the LAUSD attendance area will be drawn after all LAUSD residential students have been drawn.  The charter school disseminates outreach materials to its charter community containing the District's standard contact number (213-241-6701) to access additional information regarding enrollment procedures.  Within 5 days of acceptance a copy of the following must be received by HTLA: o Official Student Record  If a student attends an LAUSD school:  PAR Form  If a student does not attend a LAUSD school:  Official Transcript o Immunization Records o IEP or 504 (if applicable)

Student Application Lottery 2017 - 2018 Student Information: Applicant’s Name:________________________________________________________________________ Last Name First Name Middle Initial Gender: Male: ______ Female: ______

Date of Birth: ___________________________________ Month Day Year

Home Address: __________________________________________________________________________ Street Address Apt. #

City

___________________________________________________________________________ State Zip Code

Home Phone: ______________________________ Cell Phone: ___________________________________ Applicant’s Current School:________________________________________________________________ Apply Grade: 9th _____ 10th _____ 11th _____ 12th _____ Does the applicant have a sibling currently attending HTLA?

Yes: ________ No: _______

If yes, what is the sibling’s name? __________________________________________________________ (*Incoming 9th grades with siblings currently attending are automatically accepted only if their application is received between 9/16/16 – 2/10/17)

Does the applicant live in the LAUSD attendance area?

Yes: ________ No: _______

Students outside of the LAUSD attendance area will be drawn after all LAUSD residential students have been drawn.

Mother Information: Name: __________________________________________________________________________________ Last Name First Name Middle Initial Home Address: __________________________________________________________________________ Street Address Apt. #

City

__________________________________________________________________________ State Zip Code

Home Phone: _______________________________ Cell Phone: __________________________________ Work Phone: ______________________ Mother Email: _________________________________________ Father Information: Name: __________________________________________________________________________________ Last Name First Name Middle Initial Home Address: ___________________________