Editing previous response:

Please fix the highlighted areas below before submitting.

SQA Intent to Enroll Form 2027-28

Please complete the form below. Required fields marked with an asterisk *

Dear potential Synergy Quantum Academy ("High School Charter School") parents/guardians:

This form may be used to support Synergy Quantum Academy's request for facilities pursuant to Proposition 39 (California Education Code section 47614). By submitting this form, you are indicating that you are meaningfully interested in enrolling your child in a 9th-12th grade class at Synergy Quantum Academy's classroom-based program during the 2027-28 school year. Thank you very much for your support and cooperation!

Please fill out one form for EACH student.

Student Information

Student's First Name:*

Answer required for "Student's First Name:"

Student's Middle Name:

Answer required for "Student's Middle Name:"

Student's Last Name:*

Answer required for "Student's Last Name:"

Grade Level in 2027-28:*

Answer required for "Grade Level in 2027-28:"

Student's Home Address (including zip code):

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

Home Phone:

Number Required

Student's Date of Birth*

Answer required for "Student's Date of Birth"

Does this student currently attend Synergy Quantum Academy ("Charter School")?

Answer required for "Does this student currently attend Synergy Quantum Academy (\"Charter School\")?"

Yes

Is this child a resident of Los Angeles Unified School District ("LAUSD")?

Answer required for "Is this child a resident of Los Angeles Unified School District (\"LAUSD\")?"

Yes

If yes, please list the name of the LAUSD school this student would otherwise attend:

Answer required for "If yes, please list the name of the LAUSD school this student would otherwise attend:"

Parent/Legal Guardian Name:

Last, First, Middle

Answer required for "Parent/Legal Guardian Name:"

Parent's Address

Street Address

Answer required for "Street Address"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Parent's Phone Number: *

Number Required

Parent's Email:

Answer required for "Parent's Email:"

By signing below, I am indicating that I am meaningfully interested in enrolling or re-enrolling (as applicable) the above named child in Charter School for the 2027-28 school year. I understand that signing this form does not guarantee enrollment in the Charter School. I further understand that this information will be disclosed to LAUSD to support Synergy Quantum Academy's request for facilities under Proposition 39.

Signature of Parent/Legal Guardian*

Signature Required

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"