EAGLE ROCK ELEMENTARY & Magnet Center 2024-2025

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PERMIT REQUEST for 2024-25 school year
SOLICITUD DE PERMISO para año escolar 2024-25

This form is a request for a permit and it keeps your information on file.
This does not guarantee a permit will be issued.
We will determine whether or not permits are issued based on space availability.

If your student has an IEP it must be checked on this form to verify we can provide services.

Thank you for your patience.

Email *

STUDENT NAME / NOMBRE DE LA ESTUDIANTE *

DATE OF BIRTH / FECHA DE NACIMIENTO *

YYYY

GRADE FOR REQUESTED YEAR / GRADO PARA EL PRÓXIMO AÑO

PARENT NAME / NOMBRE DEL PADRE

HOME ADDRESS / DIRECCION DE CASA *

PHONE # / NÚMERO DE TELÉFONO *

EMAIL / CORREO ELECTRÓNICO *

Reason for request / Razón de la solicitud:

PARENT EMPLOYMENT

CONTINUING ENROLLMENT

SIBLING

CHILD CARE (DOES NOT INCLUDE BEYOND THE BELL)

OTHER (Enter reason below)

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OTHER Reason for request / OTRA Razón de la solicitud:

If requesting a sibling permit, name & grade of sibling(s) / Si solicita un permiso de hermano, ¿cuál es el nombre y grado del hermano?:

Name of current school of enrollment / Nombre de la escuela actual en que está matriculado:

If attending private or charter school, name of neighborhood LAUSD school / Nombre de la escuela del LAUSD de su vecindario:

For classroom placement purposes, please check all that apply / Para fines de colocación en el aula, marque todo lo que corresponda::

Student has been identified gifted (GATE) / El/la estudiante ha sido identificado dotado (GATE)

Student has an Individualized Education Plan (IEP) / El estudiante tiene un plan educativo individualizado (IEP)

Student has a Section 504 Plan / El/la estudiante tiene un plan de la Sección 504

Language spoken at home / Idioma de casa:

Send me a copy of my responses.

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