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Jill Chaifetz Transfer High School Application
This form will be used by the intake committee to track applicants who are interested in attending JCTS in the Fall. Please fill out all areas and proceed to email the following documents to
advisor@jctsmail.com
in order to be considered: School Counselor Referral Form, Transcript, Copy of IEP if applicable, School Immunization Record, Attendance Report, & Photo ID. An interview will be scheduled afterwards you have submitted all documents. IF YOU ARE A COUNSELOR COMPLETING THE FORM FOR A FAMILY YOU MUST INFORM THE FAMILY. Thank you!
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Email
*
Your answer
Student Name
*
Your answer
Who is filling out this form on behalf of the student?
*
Self (student)
Guardian
Guidance Counselor
Social Worker
Other:
Parent/Guardian Name
*
Your answer
Student Phone Number (or best number to reach you)
*
Your answer
Student Birthday
*
MM
/
DD
/
YYYY
Is the student currently 16?
Your answer
Age?
*
Your answer
Parent/Guardian Phone Number (best phone number to reach besides student cell phone)
*
Your answer
Parent/Guardian Email Address (if applicable)
Your answer
Guardian's Preferred Language
*
English
Spansih
Other:
Current Home Address
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Your answer
Who does the student reside with?
Guardian
Self
Other:
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Current High School student is attending (if discharged, use last HS student attended)
*
Your answer
Guidance Counselor's Name (if applicable)
Your answer
Guidance Counselor's Phone Name (if applicable)
Your answer
Does the student have an IEP? (Interview will be scheduled with a SPED lead to better service the student)
Yes
No
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