2021-2022 CSA New Tech High School Application

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1.	Student Last Name:*

2.	Student First Name:*

3.	Gender:*

4.	Student ID* (For current BCSC students, enter "N/A" if you do not have an ID#) Incoming Kindergarten applicants enter "N/A"

5.	Student date of birth:*
	mm/dd/yyyy

7.	Grade for the 2021-2022 year:*

8.	Current School:* (What school are you attending this year?)
	Current School:* (What school are you attending this year?)Central Middle School Northside Middle School St. Bartholomew St. Peters Columbus East High School Columbus North High School Other, please specify

9.	Do you have a sibling living with you who is currently enrolled in CSA?*

Which CSA location will your sibling(s) be attending NEXT year?
Select at least 0 and no more than 0.

CSA Lincoln Elementary (K-6)

CSA Fodrea Elementary (K-6)

CSA Central Middle School (7-8)

CSA New Tech High School (9-12)

11.	Parent/Guardian Name:*

12.	Street Address:*

13.	City:*

14.	State:*

15.	Zip Code:*

16.	Primary Phone Contact: Please include area code*

17.	Other Phone Contact 1:*

18.	E-mail Contact #1:* (Enter N/A if you do not have an e-mail address)

19.	E-mail Contact #2* (Enter N/A if you do not have an e-mail address)

20.	Does (or will) your student receive free OR reduced lunch prices? * Please use the following guidelines for qualifying for free/reduced lunch. Free or Reduced Lunch Household Yearly Income Requirements Family of 1- $22,459 Family of 2- $30,451 Family of 3- $38,443 Family of 4- $46,435 Family of 5- $54,427 Family of 6- $62,419 Family of 7- $70,411 WHO CAN GET FREE OR REDUCED PRICE MEALS? • All children in households receiving benefits from SNAP (Food Stamps) or TANF, are eligible for free meals. • Foster children that are under the legal responsibility of a foster care agency or court are eligible for free meals. • Children participating in their school’s Head Start program are eligible for free meals. • Children who meet the definition of homeless, runaway, or migrant are eligible for free meals.

21.	Does (or will) your student receive special education services (has an IEP)?*
	Does (or will) your student receive special education services (has an IEP)?* Yes No

22.	Does (or will) your student receive English as a Second Language services?*

23.	Are there siblings living in the same home who are also applying for CSA for next year?*

24.	Please type the name and grade level for the other siblings you are also applying for: YOU MUST ALSO COMPLETE AN APPLICATION FOR EACH INDIVIDUAL SIBLING

25.	Additional Comments:

26.	Clicking "DONE" at the end of this question will complete the application. You must complete a separate, additional application for each sibling. If you have any questions, please feel free to contact the following school administrators: CSA Lincoln Elementary - Brett Findley (findleyb@bcsc.k12.in.us) 812-376-4447 CSA Fodrea Elementary - Lyndsey Linneweber (linneweberl@bcsc.k12.in.us)812-376-4321 CSA Central Middle School - Jay Payne(paynej@bcsc.k12.in.us) 812-376-4286 CSA New Tech High School- Mike Reed (reedm@bcsc.k12.in.us) 812-376-4595

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