Waskowitz Environmental Leadership & Service

Puget Sound High School

APPLICATION for ENROLLMENT-Graduating class of 2018 and 2019
Student Information

Student Name: ______________________________ Gender: ____________ Birthdate: ____________

Home School: ___________________________ Circle One:

Highline School District

Other: _____________________

Graduation Year: _________________ Student ID: ________________

Home Address: _______________________________________________________________________
Phone Number: ____________________________ Email: ____________________________________
WELS Program Applying For: (circle all that apply) Classic (10

th

& 11th Grade)

Junior (11

th

Grade)

Check any/all that apply (or skip if none apply)

IEP

504

ELL [IEP/ELL Teacher Approval Signature:__________________________________

Childfind Child Find is a process designed to locate children, birth through age 21, with a suspected disability to evaluate and identify a need for special
education and related services. The Highline School District conducts specific activities for the purposes of locating, evaluating and identifying students ages birth
to twenty-one with suspected disabilities and who reside within the districts boundaries. This includes students attending private schools. Approximately ten to
fifteen percent of all children have a disability which hinders their educational development. Early identification of disabilities assists parents, students and schools
in the design of appropriate educational services.

WELS Referral Information

(check/list all)

Counselor/Teacher:______________________________School:_________________________________

Sibling/Family Member:___________________________ Relationship:__________________________

Friend: _____________________________ How do you know them: ____________________________

Other:_______________________________ How do you know them:_____________________________

Attended Leadership Training Weekend (LTW) When:_________________________________________

Attended ROOTS Literacy Camp

When:_________________________________________

Parent/Guardian Information

Primary Contact Phone

Name/Relationship: ____________________________

(Include Area Code)

Parent/Guardian #1 Name:
Home #:

Relationship: _____________________________________
Cell #: _______________________________ Work #: ______________________________

Email:

Parent/Guardian #2 Name:
Home #:

3/17/16

Relationship: _____________________________________
Cell #: _______________________________ Work #: ______________________________

Email:

WELS Program Puget Sound High School

You will be expected to comply with the expectations as outlined below. Students, please read through the following
guidelines and initial each one.

I understand that WELS is an experiential program with overnights. My attendance is required at all
school events and I am required to be in contact with my teachers should something arise. I will commit to
attending all overnight programming .________Student Initial

I understand behavior that is inappropriate (see student rights and responsibility document) or illegal, will
result in dismissal from WELS. ____Student Initial

I understand that cell phones and other electronics are not allowed at school or to be brought to camp, I
may bring the devices but will turn them in upon arrival to school if asked by my teachers, and immediately
on any overnight. __________ Student Initial

I am aware of the physical requirements for the programs. I am able to carry a 35lb pack at times for up to
6 hours a day. ________ Student Initial

Why are you applying for the WELS program?

Required Signatures:
Student/Applicant: _____________________________________ Date: ________________________________
The above student has my recommendation for enrollment in the WELS program. To the best of my knowledge, the student with training would be an
appropriate role model for elementary students.

School Official: _______________________________________ Date: _________________________________

I hereby give my permission for my son/daughter to apply and participate in the WELS program and all of the overnight programming and field
experiences that are a part of the curriculum. I understand and am willing to be a partner for success of my child in the WELS program.
In the event it becomes necessary for the school district staff who are in charge to obtain emergency care for my child, neither the staff nor the school
district assumes financial liability for expenses incurred because of the accident, injury, illness, or unforeseen circumstances.

Parent/Guardian: _______________________________________ Date: _________________________________

NEXT STEPS: all applications are still under consideration until the student is notified of their acceptance.
Students acceptance into the program will be pending until they have turned in the following:

3/17/16

Official Transcript

3/17/16

Health Physical

WELS Packet

Emergency Card