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

School Year 2019 - 2020
Please call 801-596-8489 if you have any questions.

Welcome to City Academy!

Returning Students: Please complete the following five sections below which includes the required Aspire link where you will be asked to update demographic and contact information.

New Students: Please complete all six sections on this page which includes the required Aspire Link.

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's Birthdate

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?

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 Concerns

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

Medical 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 $195.00 is due now

The balance, along with any class fees will be due in August.

Partial Payment of Mandatory Fees:

$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 Student Organization (PSO) Donation:

$5.00

Select:

Item Subtotal:

$0.00

Donation to City Academy:

Item Subtotal:

$0.00

Total:

$0.00

Payment Information

Method of Payment:

Processing Fee Rates:

Cards: 3% plus $0.50
(4.5% for foreign cards)

eCheck (ACH): $0.50

	Update name from 1. Student Information
Name of Individual on Checking Account: Name of Individual on Savings Account: Name of Business on Checking Account:
Bank Routing Number:
Bank Account Number:
Confirm Account Number:

Credit Card Number:
Expiration Date:	/
Card ID (CVV2/CID) Number:	What is the Card ID?

Cardholder Information (exactly as it appears on your statement)
	Update from 1. Student Information
Cardholder's Name:
Billing ZIP/Postal Code:

5. Aspire Link

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

6. 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. Provide 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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