young men`s leadership academy

YOUNG MEN’S LEADERSHIP ACADEMY
545 S. W.W. White Rd., San Antonio, Texas 78220
(210) 354-9652
(210) 228-3070 e-Fax
Derrick Brown, Principal
Lisa Shead Barr, Assistant Principal
Admission requirements:
 Young men must be eligible to enroll in grades 4th -7th (2016-2017).
 Young men must reside in the greater Bexar County area.
 Young men and their parents must attend parent information session.
 Young men and their parents must agree to School/Parent Compact.
Section A: Student Information
Last Name
Middle Name
Date of Birth
Social Security Number
Street Address
City
State/Zip Code
Current School District
School Name
Current Grade
Street Address
City
State/Zip Code
Phone Number
Student Dominant Language
Has your son ever been retained?
First Name
Section B: Student Education
□ No
□Yes (Grade: _____ )
Section C: Parent/Guardian Information
Last Name
First Name
Relationship to Student
Street Address
City
State/Zip Code
Phone Number
Email Address
It is the policy of San Antonio ISD not to discriminate on the basis of race, color, national origin, age, sex or handicap in its vocational programs, services or activities as required by Title VI of the Civil Rights Act of
1964, as amended; Title IX of the Education Amendments of 1972; and Section 504 of the Rehabilitation Act of 1973, as amended.
Es norma del distrito de San Antonio no discriminar por motivos de raza, color, origen nacional, sexo o impedimento, en sus programas, servicios o actividades vocacionales, tal como lo requieren el Título VI de
la Ley de Deprechos Civiles de 1964, según enmienda; el Título IX de las Emmiendas en la Educación, de 1972, y la Sección 504 de la Ley de Rehabilitación de 1973, según enmienda.
YOUNG MEN’S LEADERSHIP ACADEMY
545 S. W.W. White Rd., San Antonio, Texas 78220
(210) 354-9652
(210) 228-3070 e-Fax
Derrick Brown, Principal
Lisa Shead Barr, Assistant Principal
Student Name:
Which (if any) of these services has your child qualified for?
(In order to support our students, we must receive special program documentation along the completed application.)
□ Bilingual/ESL
□ Dyslexia
□ Gifted & Talented
□ Special Education
□ 504
□ Other: __________________
□ Speech
Please include any additional information about your child or questions in the box below.
Additional Documents Required for Admission:
(Last and Current school year)
□
□
□
□
Copy of most recent STAAR Scores
Copy of most current Report Card/Progress Report
Copy of Attendance History
Copy of Discipline History
By signing below, I acknowledge and agree that an incomplete application or failure to submit ALL required documentation
will void the application, resulting in removal from admission consideration.
 Supportive of your son's academic efforts, leadership activities, health and wellness
 Willing to commit to parent involvement and required meeting, including those prior to admission
 Willing to maintain open communication between home and school
Parent Signature
Date
It is the policy of San Antonio ISD not to discriminate on the basis of race, color, national origin, age, sex or handicap in its vocational programs, services or activities as required by Title VI of the Civil Rights Act of
1964, as amended; Title IX of the Education Amendments of 1972; and Section 504 of the Rehabilitation Act of 1973, as amended.
Es norma del distrito de San Antonio no discriminar por motivos de raza, color, origen nacional, sexo o impedimento, en sus programas, servicios o actividades vocacionales, tal como lo requieren el Título VI de
la Ley de Deprechos Civiles de 1964, según enmienda; el Título IX de las Emmiendas en la Educación, de 1972, y la Sección 504 de la Ley de Rehabilitación de 1973, según enmienda.