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Scientific Arts Interest Form
/
Formulario de interés en artes científicas
2022-2023
Please complete this form if you are a new (or returning) family and are interested in the Scientific Arts Program at Heart of LA. This form does not guarantee your spot in the program. Families will be notified via phone or email.
This is for spring programming which starts in April 2023.
Thank You. Questions? Email us at SCIARTS@heartofla.org
Complete este formulario si es una familia nueva (o que regresa) y está interesado en el Programa de Artes Científicas/Scientific Arts en Heart of LA
. Este formulario no garantiza su lugar en el programa
.
Las familias serán notificadas por teléfono o correo electrónico.
Esto es para la programación de primavera que comienza en abril de 2023.
Gracias
.
¿Preguntas? Envíenos un correo electrónico a SCIARTS@heartofla.org
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* Indicates required question
Student First Name / Nombre del estudiante
*
Your answer
Student Last Name/ Apellido del estudiante
*
Your answer
Is student New or Returning / ¿El estudiante es nuevo o regresa?
*
New / Nuevo
Returning / Regresa
Currently in an HOLA Program / Actualmente en un programa HOLA
If your child is currently in an HOLA Program, which one? / Si su hijo/a está actualmente en un programa HOLA, ¿cuál?
SmartStart
Bridges
Visual Arts / Artes visuales
LEAL
Athletics / Atletismo
HMS Music
YOLA Music
Clear selection
Student Date of Birth/ Fecha de nacimiento*
*
MM
/
DD
/
YYYY
Student Gender Identity / Identidad de género del Estudiante
*
Male
Female
Other:
Student Ethnicity & Race (Check all that apply) / Etnicidad y raza del estudiante (marque todo lo que corresponda)
*
American Indian or Alaska Native
Black or African American
East Asian
Hispanic or Latino
Indian or Bangladeshi
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
Southwest Asian
White
Other:
Required
Student Grade (2022-23)/
Grado del Estudiante (2022-23)*
*
4th
5th
6th
7th
8th
9th
10th
11th
12th
Student's School/ Nombre de escuela del estudiante
*
Your answer
Does the student have an IEP? / ¿El estudiante tiene un IEP?*
*
Yes / Si
No
If yes, what is the IEP for? / En caso afirmativo, ¿para qué sirve el IEP?
Your answer
Parent First Name/ Nombre de Padre
*
Your answer
Parent Last Name/ Apellido de Padre
*
Your answer
Parent Primary Phone Number/ Número de teléfono principal de los padres
*
Your answer
Additional Phone Number/ Numero Adicional
Your answer
Parent Email/ Correo electrónico de Padre
*
Your answer
Zip Code/ Código postal
*
Your answer
Estimated Family Income/ Ingreso familiar anual Estimado
*
$0 - $23,828
$23,829 - $32,227
$32,228 - $40,626
$40,627 - $49,025
$49,026 - $57,424
$57,425 - $65,823
$65,824 - $74,222
$74,223+
Number in Household/ Número en el hogar
*
Your answer
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