1 ENROLLMENT APPLICATION 2017-2018 Academic Year Welcome To The Delta Academy! The Delta Academy is a fully accredited, tuition-free public charter school educating students’ grades 6 - 12. The mission of The Delta Academy is to provide a safe and nurturing instructional environment in which students from various backgrounds expand their knowledge base to fulfill academic and personal goals through differentiated instruction and reinforcement of positive character traits. The Delta Academy is the only school in Clark County that utilizes four educational models to meet the needs and goals of students. These models include: 1. Traditional college preparatory model: Students attend school five days per week. 2. Online model: Students complete their work at home. Teachers are available after school on Mondays, Tuesdays and Thursdays by appointment only. These sessions are held during the evenings from 3:45pm – 5:45pm. Students may attend online school during day school hours with prior approval. You must call and schedule to reserve a space. 3. Hybrid Model: A portion of instruction is presented online and a portion is presented face-to-face with a certified teacher. 4. Dual Credit: at the College of Southern Nevada (CSN), juniors and seniors can take two free classes per semester at CSN. Enrollment Application: Complete the attached Enrollment Application and return to us along with the required documents. Fill out the Enrollment Application. The applications can be printed from our website www.deltaacademylv.com or you can pick one up in our office For multiple students, fill out an additional Enrollment Application Once complete, sign, and bring along with completed forms. Required Documents: Gather and send additional documents to complete your enrollment file: 1. Copy of Birth Certificate 2. Copy of Current Immunization Records 3. Copy of IEP (if applicable) 4. Copy of Driver’s License or ID Card 5. Copy of Utility Bill(address verification) 6. Copy of Withdrawal form from previous school and Transcripts Deliver Documents to: Via Fax: (702) 396-0848 Via Mail: The Delta Academy 818 West Brooks Avenue North Las Vegas, NV 89030 Course Selection: Upon receipt of your Enrollment Application, The Delta Academy will send you information about selecting your courses for the 2017-2018 school year.
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1
ENROLLMENT APPLICATION
2017-2018 Academic Year
Welcome To The Delta Academy! The Delta Academy is a fully accredited, tuition-free public charter school educating students’ grades 6 - 12.
The mission of The Delta Academy is to provide a safe and nurturing instructional environment in which students
from various backgrounds expand their knowledge base to fulfill academic and personal goals through differentiated
instruction and reinforcement of positive character traits. The Delta Academy is the only school in Clark County
that utilizes four educational models to meet the needs and goals of students.
These models include:
1. Traditional college preparatory model: Students attend school five days per week.
2. Online model: Students complete their work at home. Teachers are available after school on Mondays,
Tuesdays and Thursdays by appointment only. These sessions are held during the evenings from 3:45pm –
5:45pm. Students may attend online school during day school hours with prior approval. You must call
and schedule to reserve a space.
3. Hybrid Model: A portion of instruction is presented online and a portion is presented face-to-face with a
certified teacher.
4. Dual Credit: at the College of Southern Nevada (CSN), juniors and seniors can take two free classes per
semester at CSN.
Enrollment Application: Complete the attached Enrollment Application and return to us along with the required documents.
Fill out the Enrollment Application. The applications can be printed from our website
www.deltaacademylv.com or you can pick one up in our office
For multiple students, fill out an additional Enrollment Application
Once complete, sign, and bring along with completed forms.
Required Documents:
Gather and send additional documents to complete your enrollment file:
1. Copy of Birth Certificate
2. Copy of Current Immunization Records
3. Copy of IEP (if applicable)
4. Copy of Driver’s License or ID Card
5. Copy of Utility Bill(address verification)
6. Copy of Withdrawal form from previous school and Transcripts
Deliver Documents to: Via Fax: (702) 396-0848
Via Mail: The Delta Academy
818 West Brooks Avenue
North Las Vegas, NV 89030
Course Selection: Upon receipt of your Enrollment Application, The Delta Academy will send you information about selecting your
2017-2018 Academic Year Instructions: Please fill out the form below completely. Gray areas are for school use only. NRS 932.165: state law requires enrollment of student by legal name
Student Information
Students legal name: (last, first, middle initial) Gender: Grade:
Home Address: Zip Code: Student I.D:
Mailing Address/ P.O. Box: (If Different Than Resident) Zip code: Restrict Directory Info:
yes no
Personal Email: Home Phone: (w/ area code) Cell Phone Number:
SSN # Birth Date: Birth Place: (City, State)
Ethnic: Traditional or On-Line?
On-Line Day
Preference
Language:
Special ED Category
Parent/ Guardian Information: Must be completed by parent/ guardian
Relationship: DOB: Parent Last name: Parent First Name: Parent M.I:
Resides with: Yes No
Home Phone: (w/ area code) Cell Phone Number:
Personal Email: Parent Employer:
Occupation: Employer Phone Number: Work extension: Work Hours:
To
Relationship: DOB: Parent Last Name: Parent First Name: Parent M.I:
Resides with: Yes No Home Phone: (w/area code) Cell phone number:
Personal Email: Parent Employer:
Occupation: Employer Phone Number: Work Extension: Work hours
To
Non-Custodial Parent/ Guardian Information: Relationship: Parent Last name: Parent First Name: Parent M.I:
Home Address: Zip Code:
School Information: Has Student Ever Attended A Clark County School? Yes No
School: when:
Name And Address Of Last School
Attended:
Records
Release:
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ENROLLMENT APPLICATION
2017-2018 Academic Year Instructions: Please fill out the form below completely. Gray areas are for school use only. NRS 932.165: state law requires enrollment of student by legal name
DEMOGRAPHIC INFORMATION SURVEY
Sibling Information
Sibling At This School: Grade: Sibling At This School: Grade:
Sibling At This School: Grade: Sibling At This School: Grade:
Local Emergency Contact A person who may be contacted if the parent/ guardian is unavailable and who is authorized to pick up the student in an emergency
Last Name: First Name: M.I.: Grade: Date Of Birth:
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ANNUAL RELEASE AND NETWORK ACCESS FORM
2017-2018 Academic Year
Students Name (first, last):___________________________ ______ School Year:__________
School: Grade: Track: Student ID #:
Please read the attached instruction sheet carefully before signing this document. The Parent/Guardian must complete all
three sections below. (1) Restrict Release of Directory Information; (2) Media Release; and (3) Computer Network Access
1. Restrict Release of Directory Information (to be completed by the parent/guardian)
FEPRA allows The Delta Academy to release Directory Information (which is defined in the “instruction sheet”) without the
consent of the parent/guardian/ however, a parent/guardian has the right to opt-out of that disclosure. I hereby request that
Directory Information for my child NOT to be released to the following agencies or organizations:
Withhold Directory Information from military only Withhold information from all agencies
Withhold Directory information from all agencies, with the exception of allowing the release of Directory Information
solely for the purpose of inclusion in printed Delta Academy school publications such as the annual yearbook, playbills,
honor roll or other recognition lists, graduation programs, newsletters, and sports activity programs/sheets.
2. Media Release (to be completed by the parent/guardian)
I give do not give permission for the Delta Academy to release my child’s name, photograph, and/or audio/video/film
reproduction for use in INTERNAL media publications, newspaper articles, television coverage, websites (including
www.DeltaAcademyLV.com), newsletters (including school newsletters), video presentations, and/or school presentations. I
understand that the material may be reduced to either print or electronic format, and may be utilized in external media
sources.
I give do not give permission for the Delta Academy to release my child’s name, photograph, and/or audio/video/film
reproduction for use in EXTERNAL media publications, newspaper articles, television coverage, websites (including
www.DeltaAcademyLV.com), newsletters (including school newsletters), video presentations, and/or school presentations. I
understand that the material may be reduced to either print or electronic format, and may be utilized in external media
sources.
3. Computer Network Access (to be completed by the parent/guardian)
I give do not give permission for my child to access, produce, video conference, and communicate information on the
district computer network resources in accordance with acceptable use policy. Student work, artwork or projects will be
identified by first name, grade and school only. Students who do not have a parent/guardian permission to use the districts
computer network will be given alternative education activities.
The signature of the parent/guardian below applies to all three releases set forth above.
Printed name of Parent/Guardian
Signature of Parent/Guardian Date
Computer Network Access (to be completed by the student) I understand I will abide by the Acceptable Use Policy of The Delta Academy. I understand that violating the Acceptable
Use Policy may result in the loss of network privileges and/or other District disciplinary measures.
Student Signature Date
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SPECIAL INFORMATION FORM
2017-2018 Academic Year
The Delta Academy's goal is to provide the best possible educational experience for your child. We facilitate
this goal by educating children at their own ability levels. To assist us in the process, please complete the
following checklist.
1. Does your child have a current IEP? (if yes please provide copy)…… Yes No
2. Has your child ever had an IEP?……………………………………… Yes No
3. Special Education assistance in the general education classroom?…… Yes No
4. Special Education assistance in a pull out program?………………….. Yes No
5. Special Education in a contained program?…………………………… Yes No
6. A 504 accommodation plan?…………………………………………... Yes No
7. Speech/Language therapy?…………………………………………….. Yes No
8. Occupational/Physical therapy?……………………………………….. Yes No
9. Is your child under the care of a physician for special needs?………. .. Yes No
10. Has or does your child receive(d) school counseling?……………….. Yes No
11. English as a Second Language program?…………………………….. Yes No
12. Tested for Special Programs, but did not qualify?…………………… Yes No
13. Has your child ever been retained?…………………………………… Yes No
14. If you answered yes to the above question, which grade?……………__________
15. Has your child ever been expelled?………………………………….. Yes No
16. Is your child in the process of being expelled?……………………….. Yes No
If you answered yes to question 15 or 16 please provide any and all information you may have in regards to thee
expulsion. Please note that The Delta Academy is a public school and must follow the same rules and regulations
as CCSD concerning expulsions. Omitting information or falsely representing your child, null and voids this
enrollment packet.
If you answered "YES” to any of the above questions, please give Delta Academy a copy of any paperwork you
may have. This will assist us in knowing your child's educational background and special needs. Please use the
space below for any additional information you feel would benefit your child and his or her teacher regarding the
Breakfast: 8:00am – 8:30am Monday, Tuesday, Thursday and Friday
8:30 AM – 3:38 PM
Wednesday
8:30 AM – 1:00 PM
High School
Breakfast: 8:00am – 8:30am Monday, Tuesday, Thursday and Friday
8:30 AM – 3:38 PM
Wednesday
8:30 AM – 1:00 PM
Online
Monday, Tuesday and Thursday
3:45 PM – 5:45PM
Wednesdays and Fridays
By appointment only
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CODE OF HONOR
NEVADA DEPARTMENT OF EDUCATION
2017-2018 Academic Year There is a clear expectation that all students will perform academic tasks with honor and integrity, with the
support of parents, staff, faculty, administration, and the community. The learning process requires students to
think, process, organize and create their own ideas. Throughout this process, students gain knowledge, self-
respect, and ownership in the work that they do. These qualities provide a solid foundation for life skills,
impacting people positively throughout their lives. Cheating and plagiarism violate the fundamental learning
process and compromise personal integrity and one’s honor. Students demonstrate academic honesty and integrity
by not cheating, plagiarizing or using information unethically in any way.
What is cheating? Cheating or academic dishonesty can take many forms, but always involves the improper taking of information
from and/or giving of information to another student, individual, or other source. Examples of cheating can
include, but are not limited to:
Taking or copying answers on an examination or any other assignment from another student or other
source
Copying assignments that are turned in as original work
Collaborating on exams, assignments, papers, and/or projects without specific teacher permission
Allowing others to do the research or writing for an assigned paper
Using unauthorized electronic devices
Falsifying data or lab results, including changing grades electronically
What is plagiarism? Plagiarism is a common form of cheating or academic dishonesty in the school setting. It is representing another
person’s works or ideas as your own without giving credit to the proper source and submitting it for any purpose.
Examples of plagiarism can include, but are not limited to:
Submitting someone else’s work, such as published sources in part or whole, as your own without giving
credit to the source
Turning in purchased papers or papers from the Internet written by someone else
Representing another person’s artistic or scholarly works such as musical compositions, computer
programs, photographs, drawings, or paintings as your own
Helping others plagiarize by giving them your work
All stakeholders have a responsibility in maintaining academic honesty. Educators must provide the tools and teach
the concepts that afford students the knowledge to understand the characteristics of cheating and plagiarism. Parents
must support their students in making good decisions relative to completing coursework assignments and taking
exams. Students must produce work that is theirs alone, recognizing the importance of thinking for themselves and
learning independently, when that is the nature of the assignment. Adhering to the Code of Honor for the purposes
of academic honesty promotes an essential skill that goes beyond the school environment. Honesty and integrity
are useful and valuable traits impacting one’s life. Questions or concerns regarding the consequences associated with a violation of the Code of Honor may be directed
towards your child’s school administration and/or the school district.