SIPlive: City Academy - Misc Fees (L.?)

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School Year 2021 - 2022

Please call 801-596-8489 if you have any questions.

WELCOME TO CITY ACADEMY!

Returning Students: Please complete all of both parts of this online registration process. First, complete Sections 1- 4 below. Next, complete item 5A which has the Aspire link where you will finalize your registration by verifying or updating your demographic and contact information.

New Students: Please complete all of both parts of this online registration process. First, complete Sections 1- 5B below.

Next, at the end of item 5B click on the Aspire link to create your Aspire account and complete demographic and contact information on that site.

All students must go to the Aspire link below to complete your registration!

1. Student Information

First Name:	Last Name:
Address:
Address:
City:	State/Province:	ZIP/Postal Code:
Phone:
Email:

Student Birth Date

Student Grade

Has your student been suspended or expelled from any previous school?

If so, please indicate which school and briefly explain circumstances:

Has your student received any truancy (attendance) citations during the previous school year?

If so, please indicate which school and briefly explain circumstances:

Parent Name:

Parent Place of Work:

Parent Occupation:

Parent, please indicate your highest level of education:

		GED
		High School
		College - 2 years
		College - 4 years
		Masters Degree
		Other

2. Health/Medical/Learning Concerns

Please describe any health or medical (including emotional/mental) concerns or learning concerns the student has, or any 504 plan or IEP information of which City Academy should be aware so that we can best support your student.

Concerns:

3. Medical Consent Agreement

In the event of medical emergency, when parent or guardian cannot be reached or in life threatening situations, I authorize City Academy to obtain emergency medical care (i.e., physician, dentist, paramedic, or other authorized emergency medical agents) and to obtain and provide emergency transportation. I understand that I or my insurance, if applicable, will be billed for such emergency medical treatment.

I agree to the above Medical Consent Agreement

4. Mandatory Fees

Check here if you expect to qualify for free meals/fee waiver. Mandatory fees are waived if you qualify. Application form will be available in August.

Fee Waiver

Partial payment of required fees is due now.

The balance will be due in August

Partial Payment of Mandatory Fees for Grades 7,8:

$170.00

Select:

Item Subtotal:

$0.00

Partial Payment of Mandatory Fees for Grades 9-12:

$195.00

Select:

Item Subtotal:

$0.00

Mandatory Fees include the following: Activity Fee, instructional & laboratory materials, texts, technology, software, equipment licenses, and transportation fee.

Optional

Parent School Organization (PSO) Donation:

$5.00

Select:

Item Subtotal:

$0.00

Donation to City Academy:

Item Subtotal:

$0.00

To help cover fees for families who cannot afford to pay them.

Total:

$0.00

Payment Information:

Processing Fee Rates:
Cards:	3% plus $0.50 (4.5% for foreign cards)
eCheck (ACH):	$0.50

Method of Payment:
Update Name from Personal/Organizational Information

Name on Account:
Routing Number:
Account Number:
Institution:

Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:

Change Payment Method

5A Aspire Link for Returning Students Only

Finalize your registration by updating demographic and contact information by clicking here: Aspire Link

5B NEW STUDENTS ONLY - Finalizing Your Registration

How did you hear about us?

		Word of mouth
		Social media
		Google search

Other:

Your registration will be complete after you do the following 3 items:

Call to schedule and attend a meeting with our school director or counselor (801)596-8489
Submit the following items to the school office:

Birth Certificate
Immunization Record
Transcript or most recent report card
IEP/504/ESL (if applicable)

3. Finalize your registration by providing demographic and contact information by clicking on this Aspire link: Aspire Link

Once in Aspire, click on the "Have a new student?" tab on the right hand side of the page. When you have completed the form, you will be asked if you want to open an account on Aspire. We highly recommend that you do this at this time.

If you have any questions or problems, please call (801) 596-8489

We are looking forward to another great year at City Academy!

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