Primavera Online

Completed Form

Internal Use Only

Name of Employee Enrolling Student:

Date of Enrollment Form Completed: 02/02/2024
Date of Entry into PowerSchool:

Student Information

Legal First Name Elijah

Preferred First Name Eli
Legal Middle Name Michael
Legal Last Name Curnutt
Suffix
Gender Male
Preferred Gender Male
Date of Birth 1/3/2006
City of Birth Cedar City
State of Birth Utah
Country of Birth United States of America

Student Email Address [email protected]

Student Phone Number 435-515-6798
Does your student have
daily access to a reliable Yes
computer or laptop?
Does your student have
access to reliable internet Yes
on a daily basis?

Home/Residential Information

Address 16682 N West Point Pkwy

Apt / Unit 252
City Surprise
State Arizona
Only Arizona residents are able to attend Primavera. If you have questions or need additional support, please call 480-530-0632.

Zip 85374

Mailing Address

Is the student's mailing address different than the physical address listed above?
No

Contacts

Please include ALL parent(s) or legal guardian(s) and ALL emergency contacts for this student. You can enter up to 4 contacts.

Contact 1 - Will receive all communication related to student and will be responsible for approving their student's attendance
weekly.
For assistance on completing this section of the enrollment application, please watch this short video:

Video: How to complete this contacts section.

Title Mr.
First Name Matthew
Last Name Curnutt
Suffix
Gender Male
Relationship to Student Father
Are you the legal guardian
of the student or an adult Yes
student?
Receive Mailings? No
Are you authorized to
made educational
decisions, have access to
student's educational Yes
records , and approve
student's school
attendance?
Are you an emergency
Yes
contact for student?

Contact 1 Contact Information

Email Address [email protected]

Phone 1 Number 435-372-9023
Phone 1 Type Home
Best Time to Contact: 1pm to 5pm
Is this a preferred phone
Yes
number for you?
Phone 2 Number
Phone 2 Type
Best Time to Contact:
Is this a preferred phone
No
number for you?

Contact 2

Title Mrs.
First Name Kristine
Last Name Curnutt
Suffix
Gender Female
Relationship to Student Mother
Are you the legal guardian
of the student or an adult Yes
student?
Receive Mailings? No
Do you reside in the same
Yes
household as student?
Are you an emergency
Yes
contact for student?

Contact 2 Contact Information

Email Address [email protected]

Phone 1 Number 435-592-3450
Phone 1 Type Home
Best Time to Contact: 1pm to 5pm
 Is this a preferred phone
Yes
number for you?
Phone 2 Number
Phone 2 Type
Best Time to Contact:
Is this a preferred phone
No
number for you?

Additional Contact

Would you like to add

No
another contact?

Contact Priority

To adjust the priority in which contacts will be called, please select the appropriate order number next to the name.

For assistance on how to complete this section of the enrollment application, please watch this short video:

Video: How to complete the priority section.

Matthew Curnutt 2
Kristine Curnutt 1

New Student Information

Ethnicity and Race Report

This form is to be filled out by the student's parents or guardians, and both questions MUST be answered. Part A asks about the student's ethnicity
and Part B asks about the student's race.

For assistance on how to complete this section of the enrollment application, please watch this short video:

Video: How to complete the ethnicity and race section.

Part A - Ethnicity

Is the student Hispanic / Latino?

No

Part B - Race

American Indian or Alaskan Native: A person having origins in any of the original peoples of North and South America including Central America,
and who maintains a tribal affiliation or a community attachment.

Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including for example,
Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.

Black or African American: A person having origins in any of the black racial groups in Africa.

Native Hawaiian or other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Primary Race White

[ ] American Indian or Alaskan Native

[ ] Asian
[ ] Black or African American
[ ] Native Hawaiian or other Pacific Islander

Home Language Survey

 First Acquired Language
English
Home Language
English
Spoken Language
English

Migrant Worker

Did your family make a move in the past 36 months so that a parent/guardian could work as a migratory agricultural worker, or migratory
fisher?
No

McKinney-Vento

For assistance on how to complete this section of the enrollment application, please watch this short video:

Video: How to complete the McKinney-Vento section.

Š Fixed—stationary, permanent, and not subject to change

Š Regular—used on a regular (i.e. nightly) basis
Š Adequate—sufficient for meeting both the physical and psychological needs typically met in home environments.

Does the student lack a fixed, regular, or adequate nighttime residence?

No

Foster Care

Is this student a foster child?

No

Military Identifier

Under Every Student Succeeds Act (ESSA), the U.S. Department of Education requires all schools
to confirm if parents/guardians of school-age children are actively in the military. Please answer each
question below.
Active Duty – Are any of the student's parents or legal guardians currently in Active Duty as a member of the Army, Navy Air Force, Marine
Corps or Coast Guard?
No
Active Duty - Are any of the student's parents or legal guardians currently in Active Duty as a member of the National Guard (Army, Air
Guard, or State Guard)?
No
Reserve Force - Are any of the student's parents or legal guardians currently a member of the Reserve Force in the United States military
(Army, Navy, Air Force, Marine Corps or Coast Guard)?
No
Veterans - Are any of the student's parents or legal guardians within the last year, a veteran who was medically discharged or retired?
No
Other - Are any of the student's parents or legal guardians currently uniformed members of the Commissioned Corps of the National
Oceanic and Atmospheric Administration (NOAA) or the United States Public Health Services (USPHS)?
No
Are any of the student's parents or legal guardians active duty members who passed away while on active duty within the last year?
No
Household Income Survey
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies,
offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color,
national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status,
income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity
conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American
Sign Language, etc.) should contact the responsible Agency or USDA's TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA
through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at How to File a
Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information
requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S.
Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410; (2) fax:
(202) 690-7442; or (3) email: [email protected].

USDA is an equal opportunity provider, employer, and lender.

Even though our school does not serve meals, we ask you to complete this form so your school can be eligible for additional federal and state
funding. That funding is used to improve the educational program. The information you provide is kept fully confidential.

Families will be presented with the Family Income form after July 1st to provide updated information for the upcoming school year.

Number of people in household:

4
Select the appropriate
range of combined annual
income for all people in the Between $39,001 and $55,500
household. (include all
income before taxes)

Enrollment

Reason Attending

Why did you choose Primavera?

In need of additional credits

What grade are you

12
enrolling your student for?

Your student is attending Primavera for:

Concurrent Enrollment - Enrolled at another school, attending Primavera to make up credit(s) or get ahead. Will be
graduating from current home school.

Please select your course(s):

For course availability and descriptions

Š High School Courses: Click here

Course 1

Subject World Languages

Course Spanish 2A

Course 2

Subject World Languages

Course Spanish 2B

Course 3

Subject
Course
Course 4

Subject
Course

Does your student plan on graduating from Primavera?

No
Does your student plan on transferring credits to another high school?
Yes

For funding and reporting purposes, the state of Arizona requires that we document the amount of classes a student is planning on taking with
Primavera Online during the school year. We understand that the number of courses may change throughout the school year so please give your
best estimate.

How many courses will the student be taking with Primavera?

2 courses

Has your student ever

No
been suspended?
Has your student ever
No
been expelled?

Previous School Information

Has your student ever attended a public or charter school before?

Yes

Has your student been in a

Yes
gifted program?
What school(s) was your
Cottonwood Elementary School and Canyon Ridge
student identified as gifted?

Most Recent School Information

Previous School Name Shadow Ridge High School

City Surprise
State Arizona
Zip 85374
Grade Last Completed 11
Authorization for Release of Information

For the purpose of coordination of services and educational related planning, I hereby authorize the School to send and receive
information about my child with the above-mentioned school.
Yes
Second Previous School

Second Previous School

Name
City
State
Zip
Grade Last Completed
Third Previous School

Third Previous School

Name
City
State
Zip
Grade Last Completed
Special Programs

The federal government requires schools to provide a "free appropriate public education (FAPE) to each qualified student within the school's
jurisdiction. FAPE consists of the provision of regular or special education related aids and services designated to meet the student's individual
educational needs. Admissions is not limited based upon ethnicity, national origin, gender, income level, age, religion, disabiling condition,
proficiency in the English language, or athletic ability. We will request your student's records from their previous or current school as soon as you
have provided the required information for enrollment: however, that does take time. To make sure your student starts off on the right foot, we ask
that you please answer the questions below.

In order to continue to receive appropriate services, does your student currently receive special education services?
No
In order to continue to receive appropriate services, does your student currently receive 504 accommodations?
No

Marketing Survey

How did you hear about us?

Referral

Whom may we thank for referring you?

My high school counselor

Agreements

2023-2024 - Student-Parent Handbook Acknowledgment

Please read the Student-Parent Handbook.

[X] I have read and agree to the terms within

the student/parent handbook.

2023-2024 - Rights of Homeless Student

Please read the Rights of Homeless Student.

[X] I have received the Rights of Homeless

Student document

Communication

Your teachers will communicate with you regularly through phone calls,
messages, online class sessions both large and small groups, email,
and via assignments.

Instructors will return all communication within 24 hours during school

days.

All students must maintain consistent weekly communication with

instructors, school counselor, and/or case manager.

[X] I/We understand

Attendance

Attendance is extremely important for online schools. We do not take

attendance in the same way as traditional schools, where attendance
is based on whether a student was absent or present every period.
Instead, our attendance is based on the number of minutes each
student spends working in their courses. Having the correct minutes
logged into the system is critical to our school's funding and ability to
pay for our educators, software, and curriculum.

Students will complete both online and offline course work in order to
meet their weekly attendance requirements. Please see the link here
for information regarding state attendance requirements.

Attendance and Course Requirements:

Š Complete coursework 5 days out of the week.

Š Attendance should be submitted and verified daily.
Š Total attendance for a completed full week is approximately:
» Semester courses: 1 hour per course per day – 6 hours
daily
Π6 courses would be about 30 hour's weekly total.

» Twelve-week courses: 1.5 hours per course per day –

6 hours daily
ΠUp to 4 courses would be about 30 hour's weekly total.

» Six-week courses: 3 hours per day per course - 6 hours

daily
ΠUp to 2 courses would be about 30 hour's weekly total.

» Four-week summer course: 5 hours per day.

Π1 course would be about 25 hour's weekly total.

Š Failure to start and complete coursework could result in withdrawal

from Primavera Online

Per Arizona State Statute 15-808, attendance must be recorded daily

and approved weekly by the parents of each student.

[X] I/We understand

Testing

Primavera students are required to participate in state testing.

Students in grades 3-8 are required to take the Math and ELA state
assessments. Student in grades 5, 8 and 11 grades are required to
take the Science assessments. Students in grades 9 and 11 are
required to participate in the ACT assessment. Primavera provides
notification of testing dates and locations around the state through the
Primavera website, regular mail, email, and the parent/student portals.
Instructors proctor the tests on dates specified by the Arizona
Department of Education. All students must participate in the state
assessment or take a make-up test if absent during the testing dates.

Pursuant to A.R.S 15-741 the aforementioned students are required

to engage in state testing and failure to participate may result in
being unenrolled from Primavera Online.

[X] I/We understand

Enrollment

Arizona Revised Statue 15-841 C. States: A School District may refuse

to admit any pupil who has been expelled from another educational
institution or who is in the process of being expelled from another
educational institution.

All fulltime 9th to 12th grade and above students are required to set up
an Educational Career Action Plan (ECAP) and update it annually.

[X] I/We understand

Academic

State Graduation Requirement:

Š Pursuant to A.R.S. 15-701.01(A)(2), all high school students must pass

a Civics exam with a score of 70% or higher.
Š CPR Instruction
» Pursuant to A.R.S 15-718.01, Primavera provides our students
with online instruction on cardiopulmonary resuscitation. This
course does NOT certify a student for CPR or First AID. Student
(s) shall be excused from this course at the request of a parent
or guardian.

Course Requirement:

Š In order to earn credit for a course, a student must earn a passing grade
of at least 59.5% and all assignments must be submitted by 11:59pm on
the last day of the course. Additional time will not be granted.

[X] I/We understand

Directory

I/we authorize Primavera to release the following “directory information”

- Please check all that apply:

[X] Student's First and Last Name

[X] Date of Birth/Age
[X] Ethnicity
[X] Gender
[X] Mailing Address
[X] Email Address
[X] Phone Numbers
[X] Photographs
[X] Grade Level
[X] Class Rank by percentage
[X] GPA
[ ] I/we do not authorize Primavera to release
“directory information” pertaining to me/us or
my/our child.
We have been advised of our rights as outlined in the notifications of
rights under the Family Educational Rights Act (FERPA) for Elementary
and Secondary institutions and the Protection of Pupil Rights
Amendment (PPRA). “Directory information” includes, but is not limited
to: the student's name, ethnicity, gender, mailing address, email
address, phone numbers, photograph, grade level, class rank by
percentage, GPA, and current class enrollment. “Directory information”
does not include the student's social security number or the student's
ID number. (Click links below to review information)

FERPA

PPRA

Parent/Guardian or Adult Student Signature

Electronic Signature Matthew Curnutt

Today's Date 02/02/2024

Document Upload
Below for your convenience, you are able to upload required documents for registration directly into the enrollment application.

Š IMPORTANT - PLEASE REVIEW: documents or images of documents that are uploaded need to be full pages showing all four corners, and must be legible
and as clear as possible in order to be acceptable.
Š Please watch this short how to video for any additional assistance. VIDEO

If you do not have access to digital copies of these documents, a scanner or a camera, you can mail or bring copies of the applicable documents to
the school's office at:

Primavera Online
2471 N Arizona Avenue
Chandler, AZ 85225

Student Proof of Age

A certified copy of the student's birth certificate; or other reliable proof of the student's identity, including a baptismal certificate, an
application for a social security number, or original school registration records. Primavera will NOT accept state ID or a driver's license for
proof of age.

If documentation other than a certified copy of a birth certificate is provided, such documentation must be accompanied by an affidavit explaining the
inability to provide a copy of the birth certificate.

If a student is in the custody of the Department of Child Safety ('DCS'), a letter from the authorized representative of the agency certifying that the
student has been legally placed in custody of the agency must be provided. Charter schools must carefully safeguard and maintain confidentiality
regarding the status of children in DCS custody.

IMPORTANT - PLEASE REVIEW: documents or images of documents that are uploaded need to be full pages showing all four corners, and must
be legible and as clear as possible in order to be acceptable.

Proof of Age 1 PXL_20240203_053115179.MP.jpg

Proof of Age 2 NO DOCUMENT UPLOADED
Proof of Age 3 NO DOCUMENT UPLOADED

Proof of Residency

A copy of ONE of the following documents must be provided to verify your Arizona residence. If you do not have any of these documents, please
contact the School's Central Office to discuss acceptable alternatives.

Š Drivers License or State ID (non-expired)

Š Mortgage or lease statement
Š Utility bill (gas, electric, sewage, phone/Internet, etc.)
Š Bank or Credit Card Statement
Š W-2 (from most recent tax year)
Š Payroll Stub
Š Vehicle registration (non-expired)
Š Government document (ex. Social Security Administration, Department of Economic Security, etc.)
Š Additional document requirements detailed by the AZ Department of Education can be found here

IMPORTANT - PLEASE REVIEW: documents or images of documents that are uploaded need to be full pages showing all four corners, and must
be legible and as clear as possible in order to be acceptable.

Š The Proof of Residence should be current, dated within 60 days of the enrollment date, and must include your name and
physical/residential address.

Proof of Residency 1 PXL_20240203_053421331.MP.jpg

Proof of Residency 2 NO DOCUMENT UPLOADED
Proof of Residency 3 NO DOCUMENT UPLOADED

Immunization Records

Immunization Record showing immunizations are up to date (or a signed statement re: exemption pursuant to A.R.S 15-873) (not required to enroll,
but required to attend).
IMPORTANT - PLEASE REVIEW: documents or images of documents that are uploaded need to be full pages showing all four corners, and must
be legible and as clear as possible in order to be acceptable.

Please choose an option: I give permission for the school to report student immunization data to the local health department.
Immunization Records 1 Adobe Scan Jan 15, 2023 (2).pdf
Immunization Records 2 Adobe Scan Jan 15, 2023 (1).pdf
Immunization Records 3 Adobe Scan Jan 15, 2023.pdf

Academic Records

IMPORTANT - PLEASE REVIEW: documents or images of documents that are uploaded need to be full pages showing all four corners, and must
be legible and as clear as possible in order to be acceptable.

Academic Records -
NO DOCUMENT UPLOADED
Upload 1
Academic Records -
NO DOCUMENT UPLOADED
Upload 2 (Optional)
Academic Records -
NO DOCUMENT UPLOADED
Upload 3 (Optional)
[X] I am unable to upload the requested document at this time. I will provide the required documentation to the school.

Custody/Foster Care Documents

IMPORTANT - PLEASE REVIEW: documents or images of documents that are uploaded need to be full pages showing all four corners, and must
be legible and as clear as possible in order to be acceptable.

Paragraph

Custody/Foster Care
NO DOCUMENT UPLOADED
Documents 1
Custody/Foster Care
NO DOCUMENT UPLOADED
Documents 2
Custody/Foster Care
NO DOCUMENT UPLOADED
Documents 3
[X] I am either unable to upload the requested document or there are no custody agreements/court orders/Foster Care Documents. If
applicable, I will provide the required documentation to the school.

504/IEP Documentation

IMPORTANT - PLEASE REVIEW: documents or images of documents that are uploaded need to be full pages showing all four corners, and must
be legible and as clear as possible in order to be acceptable.

IEP/504 Documentation 1 NO DOCUMENT UPLOADED

IEP/504 Documentation 2 NO DOCUMENT UPLOADED
IEP/504 Documentation 3 NO DOCUMENT UPLOADED
[X] I am unable to upload the requested document at this time. I will provide the required documentation to the school.

Electronic Signature

The electronic signature and all of its related fields replaces a handwritten signature on paper and is legally binding.

I affirm that the information provided is true, correct and complete, to the best of my knowledge and belief. This electronic signature and its related
fields are treated like a handwritten signature on a paper form.

Parent/Guardian or Adult Student Signature

I Agree Yes Today's Date 02/02/2024

Electronic Signature Matthew Curnutt