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Welcome to SKILLS Private Academy

Enrollment Form

SKILLS Private Academy Enrollment Application

Student's Eligibility Area
Student Services
Does the student currently have an IEP?
Which school year will your student be enrolling in?
Date
Month
Day
Year
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Chronic Illness Form

Chronic Illness Instructions

Forms must be completed and submitted together before a chronic illness can be processed.


Medical Certification and Instructional Agreement


A physician needs to fill out the form, as well as sign and date it.


Parents are encouraged to keep copies of both forms for their records.

Exclusions and Exemptions from School Attendance 

-Physician needs to fill out the Chronic Health Form-

Instructional Agreement for Students with Chronic Health Conditions

Date
Month
Day
Year
School
South Campus
Central Campus
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Empowerment Scholarship Account (ESA)

At SKILLS, we use the Empowerment Scholarship Program.


Why is the Empowerment Scholarship important? 


It pays for your child's tuition, so there is no cost to you. It's very important that you apply and stay enrolled in the ESA program to keep SKILLS Private Academy running for your very special scholar.


Where do you apply?

https://www.azed.gov/esa/


Three things you'll need to apply

  • Birth Certificate

  • Proof of Arizona Residency

  • IEP, MET, or Outside Evaluation


All SKILLS Invoices are the same amount, regardless of your scholar's eligibility, grade, or the funding that you receive from ESA. You are responsible for paying your invoice. SKILLS doesn't have access to your funding and can't pay your invoice on your behalf. Also, ESA doesn't pay your invoice for you. You'll need to log in every quarter to pay your invoice.


Do not panic if the balance on your invoice looks significant. Depending on your funding, it will cover the amount, and you may have extra funds to use for other purposes, including our summer program.


If you are funded less than the balance on your invoice, we require that you pay the full amount you're funded. For example, if your invoice says $8,163.27 and you only received $5,000.00 from ESA, pay the full $5,000.00. SKILLS will pay the remaining balance through a SKILLS Scholarship. As your funding increases, you will pay more towards your invoice balance, and the SKILLS Scholarship will decrease until you are paid in full.


If you experience any errors with your account, you will be responsible for resolving them. SKILLS can not manage your ESA account. We are here to help as much as possible.

 

You can expect a quarterly invoice from SKILLS. Your invoice will likely be emailed to you before you receive your funding. That is completely normal. Just continue to check your account and watch for emails from ESA. Once the money is funded, pay your invoice as soon as possible.


At SKILLS, we understand it takes time to set up your ESA account and receive funding. We will remain patient as you work through the process; however, we expect you to be proactive. ESA has very strict deadlines, and you may irreversibly lose funding for the quarter if you don't submit invoices in a timely manner.


Please provide updates to melissa.mazzanti@skillsprivateacademt.org while you're working through the steps. If you have any questions or concerns, we are here to help. Melissa can assist you via email or phone (520-263-6789), or an in-person appointment can be scheduled.

SKILLS Private Academy Financial Agreement

In order to enroll at SKILLS Private Academy, an ESA application must be submitted to ADE, and proof of a contract offer must be emailed to the principal prior to your student starting at SKILLS Private Academy


South Campus- Julie.Reed@skillsprivateacademy.org

Central Campus- Lisa.Thurber@skillsprivateacademy.org

Invoices will be emailed quarterly and are expected to be paid once ESA funds are deposited in your Class Wallet. Failure to pay will result in a $100 late fee per month after the disbursement of funds to your Class Wallet. Late fees must be paid by the parent/guardian, as this is not an allowable expense in Class Wallet. If you have submitted a SKILLS invoice to the Class Wallet and it is pending, but there is a delay in ESA disbursement, no late fee will be applied. However, proof of pending status must be emailed to the principal.

If payment has not been made for two quarters or more, the scholar may be unenrolled from SKILLS Private Academy at any time. Parents will still be responsible for all unpaid quarters the scholar attended, in full or in part.

If you intend to withdraw your student from SKILLS Private Academy, you must notify the school at least two weeks before the withdrawal. If your scholar attends SKILLS Private Academy at any point during the quarter, you will be responsible for that quarter's tuition.

Date
Month
Day
Year
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SKILLS Private Academy

Legal Custody of Student Form

Indicate the person(s) who has legal custody of the child/children.
Mother/Father
Mother
Father
Other (specify below)
If the student is in Foster Care, please check the box and provide the necessary information.
Foster Care/DCS
Are you under any court order?
Yes
No
Is your current address a temporary living arrangement?
Yes
No
If yes. Is this temporary living arrangement due to loss of housing or hardship?
Yes
No
Are you a SKILLS Private Academy student not living with you parent/guardian?
Yes
No
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Student Pick-Up Authorization

I hereby inform SKILLS Private Academy that the person(s) listed below are authorized to pick up the above-named student(s) at any time. Accordingly, SKILLS Private Academy is hereby instructed to release my student(s) into the care of the following person(s).

I understand that:

Parents/guardians must inform SKILLS Private Academy of the name of the person who is picking up their child on any day when they themselves are not able to.

Acceptable ways to notify SKILLS Private Academy

  • Call the school (520-263-6789)

  • Send a note with your student

  • Leave a note at drop-off


The Authorized Pick Up Person must be at least 18 years old and will be asked to provide a photo ID to the staff.

This authorization shall remain in effect until edited or rescinded in writing by the signers of this authorization.

Date
Month
Day
Year
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Release to Exchange Professional Information

Consent SKILLS Private Academy to request records/information for the above student and for the sending agency/school to release those records. This information will be used to assist in the special education programming. All records are transferred following the guidelines set by HIPAA and FERPA.

I understand that the records may contain information regarding the diagnosis or treatment of HIV/AIDS, sexually transmitted diseases, drugs and/or alcohol abuse, mental illness, or psychiatric treatment. I give my specific authorization for these records to be released. I also understand that I may revoke the authorization in writing at any time. Please refer to the Notice of Privacy Practices ( www.hhs.gov/ocr/privacy ). I also understand that once the health information I have authorized to be disclosed reaches the noted participant, that person of the organization may re-disclose it, at which time it may no longer be protected under Privacy Laws.

Date
Month
Day
Year
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Permission to Dispense Medications in School

Student's DOB
Month
Day
Year

Dear Parent/Guardian,

In order to give your student the medication as requested and supplied by you, the following must be provided:

  • This permission form is completed and signed by a parent/guardian

  • Medication in its original prescription bottle from the pharmacy

Is SKILLS Private Academy authorized to administer Tylenol and/or Benadryl if/when needed to your student?
Yes
No
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Severe Food Allergy Questionnaire

Please complete this form for your child's food allergy. This will ensure staff members can plan effectively for your child's care while at school.

Food Allergies
My child had a reaction when he/she
Symptoms of child's food allergy reaction/intolerance include:
Onset of symptoms after Ingestion
FOR PEANUT ALLERGY: Reading food labels all the time is important. If a label indicates the food item is made in a facility that also processes peanuts, my child may consume the food item
Yes
No

ANAPHYLACTIC FOOD ALLERGY ACTION PLAN

Follow these steps if my child has a reaction at school. Check all boxes that apply to your child's care.

If my child has been exposed to the food allergen at school, staff will:

Please NOTE: Staff will call 911 WHEN the EPI-PEN is given. EMTs will take your child to the nearest local hospital emergency room for more further care.

I will bring a safe snack box for my child to use in the classroom and as a substitute for birthday treats
Yes
No
Transportation Plan:

Memo of Understanding

  1. It is the mutual responsibility of the parent and teachers to review party or field trip menus.

  2. It is understood that students are not allowed to share snacks or eating utensils in class.

  3. It is understood that the parent will complete and sign this form annually.

  4. It is understood that the parent will provide the emergency medications needed at school and sign the parent/physician Medication Consent Form.

  5. It is the responsibility of the parent to notify SKILLS Private Academy of changes in the health plan.

Parent Permission

I verify that the above information is correct. I give my permission to share this information with staff on a need-to-know basis


The information is VALID for ONE school year. An annual parent signature is required.

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