SUMMIT LEADERSHIP ACADEMY HIGH DESERT
PRE-REGIGSTRATION CHECKLIST

Student: ________________________________________________________ Grade: _________

Date: _______________ Academy of Interest: __________________________________________

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Step 1: Pre-Registration Information
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1. ____Pre-Registration Application Complete by parent or guardian
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2. ____ Unofficial Transcript ____ Attendance Record ____ Discipline __IEP
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Approval: ______________________________________ Date: __________________
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Step 2: Assessments/Evaluation
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1. __________ STAR Reading Results
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2. __________ STAR Math Results
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3. __________ Essay Comments: ______________________________________________________________________
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4. Review of Transcripts: (# of units & grade level) ______________________________________________________________________
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5. Review of Discipline Record: ______________________________________________________________________
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6. Amount of time between enrollments: _____________
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7. Attended Alternative Education Program (indicate where) __________________
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Approval: ______________________________________ Date: __________________
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Summit Leadership Academy – High Desert
Application Packet
Grade ____

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Student’s Name:
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Last Name First Name Middle Name
Student’s Social Security # ____________________ Birth Date _________ Phone _______________
Address ________________________________________ City __________________ Zip ________
Student lives with:
Mother’s Name _____________________________________ Circle one: Mother Step Mother Guardian
Address ___________________________________________ City _________________ Zip _______
Home Phone _______________________________ Cell Phone ______________________________
Place of Business ___________________________ Work Phone ____________________ Ext. _____

Father’s Name _____________________________________ Circle one: Father Step Father Guardian
Address __________________________________________ City _________________ Zip ________
Home Phone _______________________________ Cell Phone ______________________________
Place of Business ___________________________ Work Phone _____________________ Ext. ____

Who has legal custody of this student? ___________________________________________________
Yes No Are active restraining orders in place?
Yes No Are there any legal/custody papers on file?

Parent/Guardian Highest Education Level
(Please check only one per parent/guardian):
Father Mother Guardian
___ ___ ___ 14 Not a high school graduate
___ ___ ___ 13 High school graduate
___ ___ ___ 12 Some college (includes A.A. /A.S)
___ ___ ___ 11College graduate
___ ___ ___ 10 Graduate school/post graduate training
___ ___ ___ 15 Decline to state