PBSD 1537 (Rev. 10/27/2016) ORIGINAL - Department of Choice Programs and School Choice
If yes, submit official current Orders and proof of dependency, such as Student's Military ID card.
EMPLOYEE: If parent/legal guardian is a full-time employee at the school selected as your first choice preference, the Principal must verify this employment by signing below.
SIGNATURE - I have read, understand and agree to the following:
Deadlines: December 2, 2016 for Bak MSOA, The Conservatory School @ North Palm Beach, A.W. Dreyfoos Jr SOA, and Boynton Beach High School Arts Programs. Deadline of January 27, 2017 for all other schools. Incomplete or faxed applications will NOT be accepted.
Online application is preferred. Save time, money, and receive an
immediate confirmation email. Complete the online application at:
www.mypbchoiceapp.com
Race (check at least one)
Read the information on Page 2 before completing application. ONE application per child may be submitted. Parent/legal guardian and student must be full-time residents of Palm Beach County on date of submission. Falsification of information on this application could lead to ineligibility. For more information, call (561) 434-8755. Type or print legibly in blue or black ink and return completed application to: Department of Choice and Career Options, 3300 Forest Hill Blvd., C-124, West Palm Beach, FL 33406.
Gender
Home Phone No.
HOME ADDRESS MUST MATCH ADDRESS ON FILE AT SCHOOL or application will NOT be processed.
THE SCHOOL DISTRICT OF PALM BEACH COUNTY DEPARTMENT OF CHOICE AND CAREER OPTIONS Assigned SAC School
SAC #Choice Programs Application School Year 2017-2018
Signature of Parent/Legal Guardian
Student Name (first, middle, last)
Birth Date (mm/dd/yy) Name of Parent(s)/Legal Guardian(s) Current School
Grade Applying For
Signature of School Principal
Cell Phone No.
Elementary Middle High School
Student ID #
American Indian/Alaskan Native Asian/Pacific IslanderBlack/Non HispanicHispanic or Latino Multiracial White/Non Hispanic
OFFICE USE ONLY
Date
Date
Current Grade
Name of School
CHECK ONE ONLY
NAME OF SIBLING ATTENDING SCHOOL PROGRAM BIRTH DATE GRADE
My signature verifies that I declare, under penalties of perjury, pursuant to Florida Statute, Section 92.525, that I have read this application, including all sections on Page 2, and all the information stated in this application is true and correct.
I understand that ONLY ONE (1) Choice application per student may be submitted and only one application selection change will be allowed if applying online.I understand that I must provide my child's IEP, ELL, or 504 Plan prior to an audition to ensure the accommodations are provided.
1.
2.
SIBLINGS: Siblings are defined as brother, sister, half-brother, half-sister, stepbrother, or stepsister, living in the same household. Name of one (1) sibling who is already attending and will be attending the same Choice school to which this applicant is applying:
I understand that if my child is not selected for the 2017-2018 school year, a new application must be submitted for the following school year.
4.
6.
/ /F M
STRAND: Has the applicant participated in and completed a program in a similar preparatory choice theme in grades 4-5 or grades 7-8?
Yes NoIf yes, provide name of school and program:
Ethnic Origin (check one)
NOT Hispanic or Latino
3.
Parent/Legal Guardian E-mail Address
Acceptance of a Choice program takes the place of all assignments for other programs including but not limited to: Reassignment, Controlled Open Enrollment, and Opportunity Scholarships.
5.
SIBLING(S) APPLYING Name of sibling(s) currently applying to the same Choice school as this applicant:
No Yes
I have read (or had read to me), understand, and had an opportunity to ask questions about the information provided in the 2017-2018 Choice booklet and the "Procedures Manual" for Choice programs, both of which are available online at www.palmbeachschools.org/choiceprograms.
Check if siblings are twins or triplets.
Page 1 of 8
Home Address City Zip Code
MILITARY: Is the parent or legal guardian a full-time active duty service member?
PBSD 1537 (Rev. 10/27/2016) ORIGINAL - Department of Choice Programs and School Choice
DIRECTIONS - Current PBCSD students must include Student ID on the application. Students applying for kindergarten must be 5 years old by September 1, 2017. Indicate your first and second program choices by placing a "1" for your first preference and a "2" for your second preference in the columns marked "#". Only two program choices are permitted. Eligibility criteria for Choice programs are indicated in the 2017-2018 Choice booklet located at http://www.palmbeachschools.org/choiceprograms. Review the eligibility criteria prior to selection. Identification of a second choice does not decrease a student's chances of being selected to the first choice. First and second choices do not have equal chances of being selected. Programs may have limited numbers of available seats and may not have any second choice students assigned in the lottery. Completion of this application does not guarantee admission. HOME EDUCATION, VIRTUAL SCHOOLS AND PRIVATE SCHOOLS - Parents must submit transcripts/portfolio to applicant school(s) for determination of eligibility no later than February 3, 2017. Check the eligibility criteria as indicated on pages 6-8 in the 2017-2018 Choice booklet. MONTESSORI - Northboro Elementary and S.D.Spady Elementary accept applications for Pre-K students. D.D. Eisenhower Elementary accepts applications for K-5. For Northboro Elementary and S.D. Spady Elementary Pre-K3, applicants must be 3 years old by September 1, 2017 and Pre-K4, applicants must be 4 years old by September 1, 2017. AUDITIONS - Bak MSOA, The Conservatory School @ North Palm Beach, A.W. Dreyfoos Jr. SOA, and Boynton Beach High School Arts programs In order to be eligible for the Choice lottery, the student must receive an eligible audition score for Bak Middle School of the Arts, The Conservatory School @ North Palm Beach - Symphony Orchestra Program, A.W. Dreyfoos Jr. School of the Arts, and Boynton Beach High School Arts programs. Approved applicants will be notified via email and/or U.S. Mail of the audition procedures and/or time and date of student audition. Applicants who need special accommodations or translations during audition(s) should contact the Choice Coordinator at Bak MSOA, (561) 882-3801/(561) 882-3819, at Dreyfoos SOA (561) 802-6005, at Boynton Beach High School (561) 752-1200, or at The Conservatory School @ North Palm Beach (561) 494-1844. APPEALS - Parents/legal guardians who believe their child was not allowed an equitable opportunity to a Choice program during the audition or eligibility process as a result of a technical problem or inequity, may request an appeal within five (5) days of the audition. An application for an appeal of Choice program eligibility must be submitted to the Director of Choice and Career Options within five (5) school days of the audition. At the time of audition, parents are required to sign a statement acknowledging that they have five days to appeal and no appeal will be available after the five day window following a student's audition. To download the PBSD 2418 Choice Appeals Application, go to www.palmbeachschools.org/ Forms/Documents/2418.pdf. DUPLICATE PROGRAMS - If the student is applying for a Choice program that is offered at his/her zoned school, the zoned school program must be listed as the first choice or the application will not be processed, with limited exceptions. All students may apply for first choice to the following full choice schools: Suncoast Community High School, A.W. Dreyfoos Jr. School of the Arts, Don Estridge High Tech MS, Bak Middle School of the Arts, Morikami Park ES, Northboro ES, Poinciana ES, SD Spady ES, and Village Academy. TRANSPORTATION - Transportation is provided for Choice students in the form of bus stops within the Choice Transportation Zone for each school. Bus stops to Choice schools may be limited and located significantly farther from the student's home than transportation to the student's zoned school. Bus stops for Choice schools may not be within walking distance of a student's home. Additional bus stops for Choice students will not be created. It is the parent's responsibility to safely transport the student to the nearest bus stop or school regardless of where the student resides. Check the existing stops using the “Find My Bus Stop” link on our website: http://www.palmbeachschools.org/choiceprograms. Bus stops are subject to change. PALM BEACH STATE COLLEGIATE HIGH SCHOOL - Only students who will be entering 12th grade for the 2017-2018 school year who meet the criteria listed on page 8 in the 2017-2018 Choice booklet.
Choice Programs Application School Year 2017-2018
Student Name
Page 2 of 8
Apply online at www.mypbchoiceapp.com
PBSD 1537 (Rev. 10/27/2016) ORIGINAL - Department of Choice Programs and School Choice
Pre-K & ELEMENTARY SCHOOLS 2017-2018 Student Name
# PROGRAM SCHOOL LOCATION
Biomedical and Veterinary Technology Acreage Pines Loxahatchee
Health and Wellness Allamanda Palm Beach Gardens
Technology Banyan Creek Delray Beach
Technology Boca Raton Boca Raton
Spanish Dual Language Cholee Lake Greenacres
Science, Technology, Engineering, Arts, and Math (STEAM) Citrus Cove Boynton Beach
Science, Technology, Engineering, and Math (STEM) Crosspointe Boynton Beach
Science, Technology, Engineering, and Math (STEM) Cypress Trails Royal Palm Beach
International Baccalaureate Primary Years Programme Dr. Mary McLeod Bethune Riviera Beach
Montessori (K-5) D.D. Eisenhower Palm Beach Gardens
International Baccalaureate Primary Years Programme Forest Park Boynton Beach
Environmental and Animal Science Frontier Loxahatchee
E3-Energy, Environment, and Engineering Galaxy Boynton Beach
Visual, Performing, and Communication Arts Glade View Belle Glade
Technology Golden Grove West Palm Beach
Spanish Dual Language Gove Belle Glade
Biomedical and Veterinary Technology Grassy Waters West Palm Beach
International Baccalaureate Primary Years Programme Grove Park Palm Beach Gardens
Science, Technology, Engineering, Arts, and Math (STEAM) HL Johnson Royal Palm Beach
Spanish Dual Language Hagen Road Boynton Beach
Science, Technology, Engineering, Arts, and Math (STEAM) Hidden Oaks Lake Worth
Science, Technology, Engineering, Arts, and Math (STEAM) Loxahatchee Loxahatchee
Science, Technology, Engineering, and Math (STEM) Meadow Park West Palm Beach
International Baccalaureate Primary Years Programme Morikami Park Delray Beach
International Spanish Academy (ISA) New Horizons Wellington
Spanish Dual Language North Grade Lake Worth
Montessori (Pre-K3, Pre-K4, K-5) Northboro West Palm Beach
International Baccalaureate Primary Years Programme Pahokee Pahokee
Science, Technology, Engineering, Arts, and Math (STEAM) Palm Beach Gardens Palm Beach Gardens
Orchestral Strings Palm Beach Public Palm Beach
International Baccalaureate Primary Years Programme Palmetto West Palm Beach
Science (Environmental), Technology, Engineering, and Math Pine Jog West Palm Beach
Spanish Dual Language Plumosa School of the Arts (SOA) Delray Beach
Arts (Visual, Performing, and Communications)
Science, Technology, Engineering, and Math (STEM) Poinciana Boynton Beach
Math, Science, and Technology Roosevelt West Palm Beach
Montessori (Pre-K3, Pre-K4, K-5) S.D. Spady Delray Beach
Health and Wellness (Specializing in Medical Sciences) Starlight Cove Lantana
Science, Technology, Engineering, and Math (STEM) Timber Trace Palm Beach Gardens
Children's Orchestra and Performing Arts Project (COPA) The Conservatory School @ North Palm Beach North Palm Beach
Arts (Visual, Performing, and Communications) U.B. Kinsey/Palmview SOA West Palm Beach
Small School Continuum Village Academy Delray Beach
Arts (Visual, Performing, and Communications) Wellington Wellington
International Baccalaureate Primary Years Programme Westward West Palm Beach
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PBSD 1537 (Rev. 10/27/2016) ORIGINAL - Department of Choice Programs and School Choice
MIDDLE SCHOOLS 2017-2018 Student Name
# PROGRAM SCHOOL LOCATION
Communication Arts Bak Middle School of the Arts West Palm Beach
Dance
Music - Band Instrument:
Music - Keyboard/Piano
Music - Orchestral Strings Instrument:
Music - Vocal
Theatre
Visual Arts
Pre-Biotechnology Bear Lakes West Palm Beach
Math Boca Raton Boca Raton
Pre-Medical Sciences
International Baccalaureate Middle Years Programme Carver Delray Beach
Pre-Information Technology
Science, Technology, Engineering, and Math (STEM)
Pre-Information Technology Christa McAuliffe Boynton Beach
Digital Graphic Design Congress Boynton Beach
Digital Video Design
Pre-Engineering
Pre-Medical Sciences
Science, Technology, Engineering, Arts, and Math (STEAM)
International Baccalaureate Middle Years Programme Conniston West Palm Beach
Spanish Dual Language
Multimedia, Music, and Communications Crestwood Royal Palm Beach
Pre-Business/IT
Pre-Engineering
High Technology Don Estridge High Tech Middle Boca Raton
Pre-Engineering (Gateway to Technology) Eagles Landing Boca Raton
International Baccalaureate Middle Years Programme H.L. Watkins Palm Beach Gardens
Math, Science, and Robotics
Pre-Medical Sciences
Pre-Business/IT Independence Jupiter
Pre-Law
Pre-Teacher Education
Pre-Culinary Arts Jeaga West Palm Beach
Pre-Law
International Baccalaureate Middle Years Programme John F. Kennedy Riviera Beach
Pre-Culinary Arts
Pre-Information Technology
Multimedia, Music, and Communications Jupiter Jupiter
Pre-Culinary Arts
Pre-Engineering (Gateway to Technology)
Pre-Medical Sciences
Pre-Information Technology L.C. Swain Greenacres
Pre-Law
Pre-Medical Sciences
Pre-Medical Sciences Lake Shore Belle Glade
Biomedical Sciences (FAU College of Medicine) Lake Worth Lake Worth
Pre-Engineering (Gateway to Technology)
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PBSD 1537 (Rev. 10/27/2016) ORIGINAL - Department of Choice Programs and School Choice
MIDDLE SCHOOLS 2017-2018 Student Name
# PROGRAM SCHOOL LOCATION Band Lantana Lantana
Dance
Pre-Medical Sciences
Pre-Teacher Education
Pre-Culinary Loggers' Run Boca Raton Pre-Law
Pre-Medical SciencesPre-Engineering Odyssey Boynton Beach
Pre-Medical Sciences
International Spanish Academy (ISA) Okeeheelee GreenacresBiomedical Health Informatics Omni Boca Raton
Multimedia & Television Production Osceola Creek Loxahatchee
Pre-Culinary Arts
Pre-Veterinary
International Baccalaureate Middle Years Programme Pahokee Pahokee Pre-Information Technology and Television
Communications Arts Palm Springs West Palm Beach
Dance
Music - Band
Music - Orchestral Strings
Music - Vocal
Spanish Dual Language
Theatre
Visual Arts
Pre-Information Technology Polo Park Wellington Biomedical Sciences (FAU College of Medicine) Roosevelt West Palm Beach
Environmental Science / GIS Leadership Academy for Young Men
Pre-Engineering
Pre-Medical Sciences
Technology
Symphony Orchestra (Grades 6-8)The Conservatory School @ North Palm Beach North Palm Beach
Pre-Culinary Arts Tradewinds Greenacres
Pre-Teacher Education
Small School Continuum Village Academy Delray BeachLiterary and Fine Arts - Instrumental Watson B. Duncan Palm Beach GardensLiterary and Fine Arts - Theatre
Literary and Fine Arts - Visual
Literary and Fine Arts - Vocal
Literary and Fine Arts - Writing & Literature
Pre-Finance
Fine Arts Wellington Landings Wellington
Pre-Information Technology
Graphic Arts Western Pines Royal Palm Beach
Pre-Information Technology
Pre-Medical Sciences
Cambridge Academy Woodlands Lake Worth
Pre-Culinary ArtsPre-Information Technology
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PBSD 1537 (Rev. 10/27/2016) ORIGINAL - Department of Choice Programs and School Choice
# PROGRAM SCHOOL LOCATION
Communication Arts A.W. Dreyfoos Jr. School of the Arts West Palm Beach
Dance
Digital Media
Music - Band Instrument:
Music - Keyboard/Piano
Music - Strings Instrument:
Music - Vocal
Theatre
Visual Arts
International Baccalaureate Atlantic Delray Beach
International Baccalaureate Medical Sciences
Navy JROTC Boca Raton Boca Raton
Aerospace Science (BASA) Boynton Beach Boynton Beach
Dance
Digital Media
Information Technology
Marine Corps JROTC
Medical Sciences - Pre-Medicine
Music - Band Instrument:
Music - Vocal
Theatre
Visual Arts
Army JROTC Forest Hill West Palm Beach
Engineering and Technology (PLTW)
Environmental Science and Field Research
Information Technology
International Baccalaureate Diploma Programme
Tourism, Hospitality, and Resort Management
Criminal Justice Glades Central Belle Glade
Engineering and Technology
Medical Sciences - Pre-Medicine
Computer Technology John I Leonard Greenacres
Finance
International Spanish Academy (ISA)
Medical Sciences - Pre-Medicine
Engineering and Technology (PLTW) Jupiter Jupiter
Environmental Science and Field Research
Medical Sciences - Pre-Medicine
Air Force JROTC Lake Worth Lake Worth
Biomedical Sciences (FAU College of Medicine)
Criminal Justice
Culinary Arts
Drafting and Design
Early Childhood Teacher Education
Medical Sciences - Pre-Medicine
HIGH SCHOOLS 2017-2018 Student Name
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PBSD 1537 (Rev. 10/27/2016) ORIGINAL - Department of Choice Programs and School Choice
PROGRAM SCHOOL LOCATION#Early Childhood Teacher Education Olympic Heights Boca Raton
Engineering and Technology (PLTW)
Finance
Marine Corps JROTC
Tourism, Hospitality, and Resort Management
Air Force JROTC Pahokee Pahokee
Information Technology
International Baccalaureate
Teacher Education
Culinary Arts Palm Beach Central Wellington
Engineering and Technology (PLTW)
Web and Digital Design Biomedical Sciences (FAU College of Medicine) Palm Beach Gardens Palm Beach GardensCulinary ArtsGlobal Business and Entrepreneurship
Medical Sciences - Pre-Medicine
Sports Management and Recreation
Television & Film Production Technology
Tourism, Hospitality, and Resort Management
Biotechnology Palm Beach Lakes West Palm Beach
Center for Pre-Law/Law Related Careers
Early Childhood Teacher Education
Marine Corps JROTC
Medical Sciences - Pre-Medicine
Teacher Education
Auto Collision Repair and Refinishing Park Vista Lake Worth
Automotive Service Technology
Medical Sciences - Pre-Medicine
Air Conditioning, Refrigeration, and Heating Technology Royal Palm Beach Royal Palm Beach
Global Business
International Baccalaureate
Medical Sciences - Pre-Medicine
Science, Technology, Engineering and Mathematics
Band/Music Industry Santaluces Lantana
Culinary Arts
Early Childhood Teacher Education
Visual Arts (Digital Media and Photography)
Biotechnology Seminole Ridge Loxahatchee
Construction Television and Film Production Technology
American History and Law Spanish River Boca Raton
Biotechnology
Entrepreneurship
Computer Science Suncoast Riviera Beach
Innovative Interactive Technology
International Baccalaureate
Mathematics, Science, and Engineering
HIGH SCHOOLS 2017-2018 Student Name
Page 7 of 8
PBSD 1537 (Rev. 10/27/2016) ORIGINAL - Department of Choice Programs and School Choice
# PROGRAM SCHOOL LOCATIONSmall School Continuum Village Academy Delray Beach
Equine/Pre-Veterinary Wellington WellingtonFine Arts
Fire Science
Marketing
Computer Science West Boca Raton Boca Raton
Culinary Arts
Drafting and Design
Medical Sciences - Pre-Medicine
Performing Arts
Early Childhood Teacher Education William T. Dwyer Palm Beach Gardens
Finance
International Baccalaureate
HIGH SCHOOLS 2017-2018 Student Name
Page 8 of 8
# PROGRAM SCHOOL LOCATION
Palm Beach State Collegiate High School Palm Beach State College
Palm Beach Gardens Campus Only