1 STUDENT INFORMATION

Enter your child’s last name, first name and middle initial. Enter your child’s correct address, including the apartment number, if any, city and zip code. It is the parent/legal guardian’s responsibility to

verify the address. Any changes of address must be made at the current LAUSD school of attendance by November 10, 2016. P.O. Boxes are not accepted.

Enter the grade level your child is in this school year and the grade level he or she will be in next school year (2017-2018). Fill in the bubble for your child’s gender.

DO THIS NOT THIS X

WHEN FILLING OUT THE APPLICATION:

If your child has ever been enrolled in an LAUSD school, please fill in the “Yes” bubble. (This does not include Independent Charter Schools). If your child has never been enrolled in an LAUSD school, please fill in the “No” bubble. Enter the name of the school your child is currently attending. Enter your child’s date of birth in this format: MM/DD/YYYY. Enter your telephone number and your work, emergency or cell phone number. Enter the parent or legal guardian’s name and e-mail address. See Kindergarten and First Grade Age Requirements on Page 4.

2 STUDENT’S ETHNICITY/RACE

Magnet and PWT are Court-Ordered programs that require parents to mark ONE federally identified ethnicity/race category on the application.

Fill in the bubble next to the ethnicity or race that best describes the child for which you are applying. You may fill the “Multi-racial/Multi-ethnic” response to indicate the applicant is identified as more than one ethnicity/race but your application WILL NOT be processed unless you select one of the federally identified ethnicity/race categories for the purpose of selection.

3 PROGRAM SELECTION

SELECT EITHER OPTION A MAGNET OR OPTION B PWT, YOU MAY NOT CHOOSE BOTH

Option A | MAGNET PROGRAM

Fill in the bubble in option A ONLY if you are applying for the Magnet Program. This option allows you to select a Magnet Program for your child to attend. Fill in this bubble if you are ONLY interested in applying for a

Magnet Program and not any other type of program. You have the option to list up to three different choices of Magnet Programs. Please do not list the same Magnet Program more than once. Please note that the second and third choices are optional. The Magnet Priority Points will be used for the applicant 's first and optional second or third choice. If the applicant is selected to any one of

their choices, the student will not be on the waiting list for the other choice(s). If not selected to their first choice applicants will be consid-ered for their second and/or third choice. If there is no available space in any of their choices, the student will be placed on the waiting list for their first choice only.

If the applicant does not get selected into a Magnet Program, the applicant will be placed on a waiting list for their First Choice Only. Any priority points that they may have had will be used, once they are placed on this waiting list.

Please See pages 12-28 for the seven-digit school code and name of the Magnet. Place one number in each box and write the school name in the box to the right .

Applicants currently attending a Magnet and selected into another Magnet will automatically be dropped from current Magnet program.

2017-2018 Choices | Application Instructions

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AMERICAN INDIAN/ALASKAN NATIVEA person having origins in the originalpeoples of North America, who main-tains cultural identification through tribal/community affiliation.

ASIAN A person having origins in theoriginal peoples of the Far East, South-east Asia, or the Indian Subcontinent, e.g., China, India, Japan, Korea and thePhilippines.

AFRICAN AMERICAN/BLACK, NOTOF HISPANIC ORIGIN A non-Hispanic person having origins in any of the Black racial groups of Africa.

HISPANIC/LATINO A person of Mexican,Puerto Rican, Cuban, Central or South-American or other Spanish culture or origin, regardless of race.

WHITE A non-Hispanic person havingorigins in any of the original peoples ofEurope, North Africa or the Middle East,e.g., England, Egypt, Russia or Iran.

NATIVE HAWAIIAN/PACIFIC ISLANDERA person having origins in any of the original peoples of Polynesia, Microne-sia or Melanesia.

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3 PROGRAM SELECTION (Continued)

SELECT EITHER OPTION A MAGNET OR OPTION B PWT, YOU MAY NOT CHOOSE BOTH

Option B | PWT - Permits With TransportationFill in the bubble in option B if you are applying for the Permits With Transportation (PWT) Program. Once students are accepted into the PWT Program, they are allowed to matriculate to the next school level (elementary to middle or middle to high) without filling out a new application, providing that space continues to be available. Please visit: eChoices.lausd. net or call (213) 241-6572 to find out if you are eligible.

4 SIBLING INFORMATION FOR MAGNET OR PWT

If this applicant has a brother or sister currently enrolled in the same Magnet or PWT school for which he/she is applying and the sibling will be continuing next year, please fill in the sibling’s last name, first name, middle initial and birth date. Points are assigned if the sibling is attending the applicant's 1st choice magnet school. Siblings must reside at the same address at the time of application. It is the parent’s responsibility to verify that the siblings have the same address on file in the District’s computer system at the current LAUSD school of attendance by the application deadline.

5 INFORMATION SHARING

Depending on seat availability at the particular Magnet program(s) you have selected, your child may be placed on a waiting list for the 2017-2018 school year. Other Magnet programs of possible interest to you may have space available for the 2017-2018 school year.

Fill in the “yes” bubble if you want to share your child’s information.

6 SIGNATURE OF PARENT/LEGAL GUARDIAN

Sign your name and write the date in the box provided to verify that all information submitted on the application is correct. If the applicant is selected, your signature authorizes the transfer of student records to the Magnet or PWT School. This application must be signed in black or blue ink.

Falsification of information will result in the applicant’s removal from the program. Double-check your information. It is the responsibility of the parent or legal guardian to complete the application correctly.

Your signature on the application signifies that you have read and understood the Choices Application Guidelines and Instructions.

Please contact Student Integration Services at (213) 241-4177 if you have any questions.

Student Integration Services will be closed from December 26, 2016 to January 2, 2017.

2017-2018 Choices | Application Instructions

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If your child is placed on a Magnet waiting list, do you want his/her name shared with other schools that may have space available?See information on page 16.

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PROGRAM PARTICIPATION IS ONLY FOR STUDENTS WHO LIVE WITHINTHE BOUNDARIES OF THE LOS ANGELES UNIFIED SCHOOL DISTRICT

You may apply online at echoices.lausd.net or by completing this application.• ONLY one on-time application will be accepted and must be for the grade the applicant will be in during the 2017-2018 school year.• Application must be complete. Submit an original application only, no copies will be accepted.• Return by U.S. mail using the enclosed envelope. Please make and retain a copy of this application for future reference.• Applications must be postmarked or received by the Los Angeles Unified School District by Thursday, November 10, 2016.• Select one of the following program options: Option A. Magnet or Option B. PWT. • Please note that it is optional to list a second and third choice when selecting the Magnet program.

2017-2018CHOICES

APPLICATIONTHIS APPLICATION MAY ONLY BESUBMITTED FOR THE 2017-2018 SCHOOL YEAR. OTHER APPLICATIONSW I L L N O T B E P R O C E S S E D .

1. STUDENT’S LAST NAME STUDENT’S FIRST NAME MI

2. STUDENT’S ADDRESS – NUMBER AND STREET (P.O. BOXES ARE NOT ACCEPTED) APARTMENT NO.4. GRADE THIS

SCHOOL YEAR2016-2017

5. GRADE NEXTSCHOOL YEAR2017-2018

3. CITY ZIP CODE

Male Female

7. SCHOOL NOW ATTENDING

Yes No

8. STUDENT’S BIRTHDATE 9. HOME TELEPHONE NUMBER 10. WORK OR EMERGENCY TELEPHONE NUMBER EXTENSION

MONTH DAY YEAR AREA CODE AREA CODE11. PARENT/LEGAL GUARDIAN’S LAST NAME PARENT/LEGAL GUARDIAN’S FIRST NAME MI

12. PARENT/LEGAL GUARDIAN’S EMAIL ADDRESS

We may use the email address you provide to inform you of the status of your child’s application.

American Indian/Alaskan Native Hispanic/Latino You may fill in “Multi-racial/Multi-ethnic”; however, by Court Order, you MUST also bubble ONE federally identified ethnicity/race category to the left for the purpose of Magnet/PWT selection. Application will not be processed unless an ethnicity/race is also indicated.

Asian White

African American/Black Native Hawaiian/Pacific Islander

Multi-racial/Multi-ethnic

PROGRAM SELECTION - SELECT ONE OF THE FOLLOWING OPTIONS: A. MAGNET OR B. PERMITS WITH TRANSPORTATION (PWT)

A. MAGNET PROGRAM – TRANSPORTATION MAY BE PROVIDED (SEE PAGE 4)

MAGNET This option allows you to select a Magnet program by making up to three choices. Print the school code and the full name of the Magnet Program for which the student isapplying. School codes are located in front of the school name on Pages 12-28. (If applying to a gifted/high ability/highly gifted Magnet, please see requirements on page 24-25).

1ST CHOICE: SCHOOL CODE FIRST MAGNET SCHOOL YOU ARE REQUESTING (Please print school name exactly as it appears on Pages 12-28).

2ND CHOICE: SCHOOL CODE (OPTIONAL) (OPTIONAL) SECOND MAGNET SCHOOL YOU ARE REQUESTING (Please print school name exactly as it appears on Pages 12-28).

3RD CHOICE: SCHOOL CODE (OPTIONAL) (OPTIONAL) THIRD MAGNET SCHOOL YOU ARE REQUESTING (Please print school name exactly as it appears on Pages 12-28).

B. PERMITS WITH TRANSPORTATION (PWT) PROGRAM – TRANSPORTATION WILL BE PROVIDED (SEE PAGE 4)

PWT This option allows you to select a PWT Program. Please fill in this bubble if you live in a PWT Sending Area. Call (213) 241-6572 orvisit the eChoices.lausd.net website to check and see if your address qualifies. The District will assign a school for your child to attend.

Has your child ever been enrolled in an LAUSD school?

6. STUDENT’S GENDER

STUDENT INFORMATION - Please complete the information below.

If the above applicant has a sibling currently enrolled in the same program for which he/she is applying (1st choice only) and the sibling will be continuing next year, please fill out the sibling’s information

STUDENT’S ETHNICITY/RACE – FILL IN ONLY ONE

SIBLING INFORMATION FOR MAGNET OR PWT

SIBLING’S LAST NAME SIBLING’S FIRST NAME MI SIBLING’S BIRTHDATE

MONTH DAY YEAR

INFORMATION SHARING

Yes No

SIGNATURE

For the student to be eligible for selection or assignment, all information must be complete and accurate. The application must be signed in black or blue ink. Falsification of information will result in an application not being processed and/or an applicant’s removal from the program. It is the responsibility of the parent/legal guardian to read all magnet application guidelines and instructions and to complete the application correctly or it will be rejected.

SIGNATURE OF PARENT OR LEGAL GUARDIAN (USE BLACK OR BLUE INK) DATE

MONTH DAY YEAR

If your child is placed on a Magnet waiting list, do you want his/her name shared with other schools that may have space available? See information on page 30.

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