Please complete ONE application for each child in the family if more than one. (Martin County students will only be considered for enrollment in Mosaic Digital Academy if found eligible).


All applicants must provide:

  • Proof of address (Parent/Guardian’s name and address must be showing on the proof of address.Not acceptable: driver’s license, voter’s registration card, or cable bill)

ONE of the following documents is required as Proof of address:

  • Current utility bill – within the last 30 days
  • Official rent receipt
  • Current mortgage deed
  • Signed lease agreement
  • Mortgage payment coupon
  • Builder’s Contract (6 month completion)
  • Affidavit of Residence

If the student is a kindergartner, you MUST provide:

If the student is a 7th grader, you MUST provide:

If the student is new to the district/state, you MUST provide:

I. STUDENT PROFILE


Race:

  • American Indian or Alaska Native. A person having origins in any of the originals peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.
  • Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, e.g., 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 of 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.

Ethnicity:

  • Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
  • Not Hispanic or Latino.

Student social security numbers are collected in order to identify students within the District’s computer system and will be used only for that purpose.)



II. GUARDIAN INFORMATION: Residential/Custodial Parent





III. PREVIOUS PROGRAM INFORMATION


Indicate if any apply to your child:


IV. DIVERSITY INFORMATION



V. SIBLINGS


Please list all siblings. Of the siblings listed, please check which are currently attending or applying for your first choice school.
Siblings are defined as brother, sister, half-brother, half-sister, stepbrother or stepsister living in the same household.



VI. EQUIPMENT INFORMATION



VII. MEDICAL INFORMATION



AGREEMENTS AND CONSENT


  • I understand that in case of emergency if my child is at a school site my child will be taken to a hospital and given the necessary treatment.
  • I understand that I am to pay the bill, including emergency transport.
  • I understand that certain educational records of my child will be shared with the district Health Care Partners as needed to provide and evaluate health services to students.
  • I also understand and agree that my child’s medical treatment records created by health care personnel at school may be shared with school officials who have a Legitimate Educational Purpose for accessing such treatment records.
  • I also consent that the school district and their health partners are able to bill Medicaid for any services for which my child is eligible.

If an application is completed for a currently enrolled student, the current seat will no longer be available.

  • I have read and understand the directions for applying for my child’s assignment.
  • I agree to abide by the policies of St. Lucie County Public Schools.
  • I testify that all of the information on this form and the documentation submitted with my request are true and accurate.
  • I understand that failure to comply with these conditions, or falsification of any portion of this application may result in the revocation of my assignment.

UPLOAD REQUIRED DOCUMENTATION