Application

Register your child for summer school 2022

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Application Form

If you do not have the form completed and all required information at the time of your appointment, your appointment will be rescheduled. All students must be five years old by September 30th to enter kindergarten and six years old by September 30th to enter first grade. There is an exception for kindergarteners that take and pass the Early Entrance Application, they must be five years old by December 31.

What Do I Need to Enroll My Child K-5th?

Birth Certificate
Social Security Card
Immunization Records
If Student is Special Needs, all Special Education Records, including IEP/ETR paperwork
Valid Parent/Guardian Drivers License
Current original lease agreement, deed or mortgage statement (If you are not the leaseholder of your residence, you must submit a Residency Affidavit)
One of the following (dated within 30 days of July): utility bill (gas, electric or water), paycheck stub, bank statement, Ohio Human Services, Social Security Paperwork.
After July 1, 2021 Free & Reduced Lunch Form
Student’s Most Recent Report Card
Proof of TB test for any student who was born or lived outside the United States (if applicable)
Completed Enrollment Packet

Della School of Coding & Design is committed to the concept of an open door policy and equal educational opportunity. In accordance with federal and state laws, and school policy, DSCD does not discriminate in any of its policies, procedures or practices on the basis of age, color, sex, religion, national origin, race, creed, or disabilities.

School Enrollment Form

Enrollment Date

Email Address

Name

Student Name

Student Address

Gender

Date of Birth

City of Birth

Applying for Grade

Last Four Digits of SS

Has this child ever attended DSCS?

Ethnicity

Is this student of Hispanic/Latino Heritage?

Native Language

Is your child proficient in English?

Residential Parent/Guardian 1: Full Name

Relationship

Occupation/Location

Business Number

Home Number

Cell Number

Parent Guardian 2: Full Name

Relationship

Occupation/Location

Business Number

Home Number

Cell Number

Parent Guardian Information: Child lives with:

Parents are:

Are there any custody, visitation, or other orders limiting access to this child?

Sibling Information: Does this student have any siblings that will be or already are enrolled at DSCD? If yes, fill below: Sibling Name & Grade

*ETP/IEP Services: Does your child have a current IEP for academics, speech, occupational or physical therapy?

Former School Information: School District of Residence

Former School Information (other than pre-school):

Name of Former School

Address of Former School

Withdrawal Date

Was your child suspended, expelled (forced to withdraw), or under discipline at the previous school attended? Yes please explain

Emergency Contact Information: Name

Home Address

Cell Phone

Relationship

Emergency Instructions: Please choose one option

Please provide doctor name and address and preferred hospital

6 + 8 =

Please note below

*ETP/IEP Services

If yes, please provide a copy of the ETR and IEP or fill out and sign a records release form so that we can request a copy from your child’s previous school.

Your child will not receive any of these services until we receive a copy of his/her IEP.

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Due to the Missing Child Law (O.R.C. Sec. 3313.672), a copy of every student’s birth certificate or other acceptable substitute must be on file. If documentation is not presented within 14 days of enrollment we are required by law to notify our local law enforcement agency. This is for the protection of your child. If this student is court placed into the care of a legal guardian, a copy of the court document must accompany this enrollment application and is good for only one(1) school year or the terms of the court papers or if address changes, whichever comes first. If a divorce situation exists, a certified full copy of the order or decree is required. Only court-ordered custody documents are accepted. I certify that the above-stated information is correct and further understand that parts of it will be used to retrieve a State-Wide Identification Number required by House Bill 282 for my student. I state that the information provided is true. I am aware that Della School of Coding & Design may use any legal means to verify my residence. I understand that falsification of information may be because of the immediate withdrawal of my student from Della School of Coding & Design and subject me to applicable criminal and civil penalties.

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Once you submit the enrollment form, you will receive an email for contractual documents for you to sign and date.

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Note: If legal custody of a child is split between two parents, please email (stemdlseducation@gmail.com) a certified copy of the court order identifying each parent’s respective award of physical custody. You are responsible to immediately inform the school of any changes to the court order.

Note: If any changes occur, please notify the school immediately!

OUR SCHOOL

CONTACT US

2747 Winchester Pike, Columbus, OH 43232

(614) 824-2717

stemdlseducation@gmail.com

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School Hours: 8:30 AM to 3:30 PM
Before Care: 7:30 AM 8:00 AM
After Care: 3:30 PM – 5:30 PM