City Academy - Misc Fees
             
School Year 2022 - 2023
Please call 801-596-8489 if you have any questions.
WELCOME TO CITY ACADEMY!
We look forward to seeing our returning and new students at City Academy this year.
 
Student Information
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone:
Email:
Student Birth Date
Student Grade
Parent Name:
Parent Place of Work:
Parent Occupation:

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

*NEW STUDENTS ONLY:

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:
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:
How did you hear about us?
Word of mouth
Social media
Internet search
New Students - Please remember the following things need to be done:
  1. Call to schedule and attend a meeting with our school director or counselor (801)596-8489
  2. Submit the following items to the school office:
  • Birth Certificate
  • Immunization Record
  • Transcript or most recent report card
  • IEP/504/ESL (if applicable)
Continue filling out the rest of this form.

ALL STUDENTS:

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 if you haven't checked the above "Fee Waiver" box.
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
(1.5% surcharge for foreign cards)
eCheck:$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


Instructions to complete your registration:

  1. Click Continue below then Submit when it comes up.
  2. You will then be directed to a page where you will see the application you just completed. Scroll to the bottom of the page and on the very bottom of the page, click on the large CLICK HERE to complete your student information in our Aspire system.
Your registration will not be complete if you don't complete these two steps and the Aspire portion.
Please contact us if you have any questions or problems.
We are looking forward to another great year at City Academy!
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