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EAK Interest list 20/21 school year
This form is to collect information for students who may be interested in EAK beginning in January 2021. Classes will only be available if the enrollment numbers and health department allow.
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Registration
Students must turn 5 years old between December 3, 2020 and February 28, 2021 to qualify for EAK. If your student is accepted into the EAK program you will be notified with instructions to begin online registration.
Student First Name - must match legal name on birth certificate
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Your answer
Student Last Name - must match legal name on birth certificate
*
Your answer
Student's Date of Birth - must turn 5 yrs old between Dec 3 - Feb 28, 2021
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MM
/
DD
/
YYYY
Parent Legal Name - First & Last
*
Your answer
Street Address where student/parent reside - include apartment or unit number if applicable
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
Parent Contact Phone #
*
Your answer
Parent Email Address - registration is attached to email, must have active email on file
*
Your answer
Preferred Program - select English or Spanish Immersion (if available)
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English Preferred choice
Spanish Immersion Preferred choice
Any available
Do you have other students enrolled in the LUSD district
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Yes
No
Does your student receive any Special Education services
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Yes
No
If so, which services
Option 1
Does your student have any health concerns (allergies, etc.) we should be aware of?
Your answer
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