Heartland 25/26 Open Enrollment Form

Heartland 25/26 Open Enrollment Form

Please complete this form if you are interested in enrolling for the 25/26 school year. An application will be emailed to you shortly.
Things to note:
- Completing this form does not guarantee enrollment.
- You will receive an application via email and it must be completed within the allotted time frame.
- We currently have spots available in the following counties/zip codes:
  - Kern (These Zip Codes only: 93255, 93527, 93528, 93554, 93555, 93516, 93519)
  - Inyo
  - North SLO County (These zip codes only: 93422, 93426, 93432, 93446, 93451, 93453, 93461, 93465)
  - San Bernardino (These Zip Codes only: 92301,92311, 93558, 93562)
  - Ventura (These Zip Codes only: 93001, 93002, 93003, 93004, 93010, 93011, 93012, 93022, 93023, 93030, 93031, 93032, 93033, 93034, 93035, 93036)
- We are only enrolling students in grades TK - 10th.
- We are not accepting students in 11th or 12th grade.
- You will receive an automatic reply upon completion of this form.
- Someone from our Enrollment Team will be in contact with you soon.
* Student's must be born on or before 9/1/21 in order to enroll in TK *
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email Address (your application will be sent to the email you provide)*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.
Address of Residence*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your county of residence?*
What is your zip code of residence?*

Student Information
How many students are you planning to enroll?*

123456

1 Student
1st Student Name*

First NameLast Name
1st Student Date of Birth*

MonthDayYear
Date
1st Student Incoming Grade Level (what grade will they be in for the 25/26 school year?)*

2 Students
1st Student Name*

First NameLast Name
1st Student Date of Birth*

MonthDayYear
Date
1st Student Incoming Grade Level (what grade will they be in for the 25/26 school year?)*
2nd Student Name*

First NameLast Name
2nd Student Date of Birth*

MonthDayYear
Date
2nd Student Incoming Grade Level (what grade will they be in for the 25/26 school year?)*

3 Students
1st Student Name*

First NameLast Name
1st Student Date of Birth*

MonthDayYear
Date
1st Student Incoming Grade Level (what grade will they be in for the 25/26 school year?)*
2nd Student Name*

First NameLast Name
2nd Student Date of Birth*

MonthDayYear
Date
2nd Student Incoming Grade Level (what grade will they be in for the 25/26 school year?)*
3rd Student Name*

First NameLast Name
3rd Student Date of Birth*

MonthDayYear
Date
3rd Student Incoming Grade Level (what grade will they be in for the 25/26 school year?)*

4 Students
1st Student Name*

First NameLast Name
1st Student Date of Birth*

MonthDayYear
Date
1st Student Incoming Grade Level (what grade will they be in for the 25/26 school year?)*
2nd Student Name*

First NameLast Name
2nd Student Date of Birth*

MonthDayYear
Date
2nd Student Incoming Grade Level (what grade will they be in for the 25/26 school year?)*
3rd Student Name*

First NameLast Name
3rd Student Date of Birth*

MonthDayYear
Date
3rd Student Incoming Grade Level (what grade will they be in for the 25/26 school year?)*
4th Student Name*

First NameLast Name
4th Student Date of Birth*

MonthDayYear
Date
4th Student Incoming Grade Level (what grade will they be in for the 25/26 school year?)*

5 Students
1st Student Name*

First NameLast Name
1st Student Date of Birth*

MonthDayYear
Date
1st Student Incoming Grade Level (what grade will they be in for the 25/26 school year?)*
2nd Student Name*

First NameLast Name
2nd Student Date of Birth*

MonthDayYear
Date
2nd Student Incoming Grade Level (what grade will they be in for the 25/26 school year?)*
3rd Student Name*

First NameLast Name
3rd Student Date of Birth*

MonthDayYear
Date
3rd Student Incoming Grade Level (what grade will they be in for the 25/26 school year?)*
4th Student Name*

First NameLast Name
4th Student Date of Birth*

MonthDayYear
Date
4th Student Incoming Grade Level (what grade will they be in for the 25/26 school year?)*
5th Student Name*

First NameLast Name
5th Student Date of Birth*

MonthDayYear
Date
5th Student Incoming Grade Level (what grade will they be in for the 25/26 school year?)*

6 Students
1st Student Name*

First NameLast Name
1st Student Date of Birth*

MonthDayYear
Date
1st Student Incoming Grade Level (what grade will they be in for the 25/26 school year?)*
2nd Student Name*

First NameLast Name
2nd Student Date of Birth*

MonthDayYear
Date
2nd Student Incoming Grade Level (what grade will they be in for the 25/26 school year?)*
3rd Student Date of Birth*

MonthDayYear
Date
3rd Student Incoming Grade Level (what grade will they be in for the 25/26 school year?)*
4th Student Name*

First NameLast Name
4th Student Date of Birth*

MonthDayYear
Date
4th Student Incoming Grade Level (what grade will they be in for the 25/26 school year?)*
5th Student Name*

First NameLast Name
5th Student Date of Birth*

MonthDayYear
Date
5th Student Incoming Grade Level (what grade will they be in for the 25/26 school year?)*
6th Student Name*

First NameLast Name
6th Student Date of Birth*

MonthDayYear
Date
6th Student Incoming Grade Level (what grade will they be in for the 25/26 school year?)*

Timeline Information
After you have submitted this form, you can expect the following:
- 1 to 2 weeks after completing the form: Applications will be sent. They will be emailed to the email address you have listed above. The application link will come from enrollment@heartlandcharterschool.com
- From completion of application through mid-May: No activity will take place.
- Mid-May through June: You will be assigned a teacher
- June: You will be fully enrolled and you will receive an email from Enrollment with confirmation.
- July: You will sign your Master Agreement with your teacher.
In the meantime, please review this helpful resource which will prepare you for the coming admissions application.
By signing this form I am acknowledging that all information entered above is true and accurate and that I have read and understood all information.*

Clear
Should be Empty:

Student Information

1 Student

2 Students

3 Students

4 Students

5 Students

6 Students

Timeline Information