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Ref # _________________

Date: _________________

Da Vinci Charter Academy Application
I am applying for the high school program on the Valley Oak campus: ____10th grade ____ 11th grade ____12th grade

Submit this form and personal statement to DV High School, 1400 E. 8th Street, Davis, CA 95616

Deadline for incoming high school application is 4:00PM on Monday, March 7, 2016.
I am applying for the junior high program on the Emerson campus: _____ 7th grade ____ 8th grade ____ 9th grade

Submit this form and personal statement to DV Junior High, 2121 Calaveras Ave., Davis, CA 95616.)

(Deadline for incoming junior high applications is 4:00PM on Tuesday, March 29, 2016.)
You will also need to provide a recommendation form completed by someone outside the applicant’s family. Good sources for a recommendation include, but are not limited to, a teacher, a neighbor, a clergy person, or another adult that knows the applicant well. Recommendation forms must be sent directly to Da Vinci in a sealed, signed envelope by the application deadline. All applicants will also submit a course request sheet. Junior High applicants not attending school in DJUSD need to take a math placement test at Da Vinci Junior High. More information will be provided upon acceptance.
All forms are available in our office, by mail if requested, or online at
Please type or print neatly
Student Name: Gender: ________ Student Birthday: ___/___/____

Last First MI Month / Day / Y ear

Language spoken at home:
Current math class and grade: __________________________ Planned math course 2016-17: ___________________________
Does your student receive services for ____ ELL ____504 ____AIM/GATE ___ IEP ___Other: _______________________
Student’s current school of attendance and grade level: ___________________ ID# _______________ State __________
Student’s previous school of attendance and grade level: __________________ ID# ________________ State __________
Any sibling(s) currently attending Da Vinci? __________ If yes, provide name and location _________________________
Is student’s parent/guardian an employee of DJUSD? _______ If yes, provide name and location _______________________
Has student ever been expelled or in the process? When? ______________________________________________________
How did you hear about Da Vinci? _________________________________________________________________________

Names and addresses of both parents/legal guardians: ­­­­­­­­­­­­­­
1) Name_________________________________________________________________ Relationship__________________

Mailing address:

Street City State Zip
E-mail : _________________________________ Preferred contact number(s): ________________________________
2) Name_________________________________________________________________ Relationship_________________

Mailing address:

Street City State Zip
E-mail : _________________________________ Preferred contact number(s): ________________________________

If my child is accepted to Da Vinci Charter Academy, my child and I are committing him/her to attend DVCA for one semester beginning in August of 2016.

I understand, as with any program, that the Davis Joint Unified School District reserves the right to make curriculum and operational changes at Da Vinci Charter Academy. Failure to divulge or falsification of information is cause to revoke admission.
Signed: Date:

Parent/Legal Guardian

Signed: Date:


Before submitting your application and personal statement, please check:
That the student applying has read, completed, and signed this application.

____ That a parent/guardian has read and signed this application.

____ That all junior high students and high school students from outside DJUSD have also submitted a

course request sheet. Catalog, course lists and course request sheets can be found on the DVCA website. .
Name: Current grade: _______________

Please Print
Please respond to the following topic. The purpose of this essay is to know you better. Express yourself honestly and to the best of your ability in the space below. If needed, continue on a separate piece of paper, or you may include a typed essay. In either case your essay should be a minimum of 300 words. Any additional sheets should be stapled to this sheet. By signing below, you are acknowledging that the essay being submitted is wholly your own.

Student Signature
Please address the following questions:

a. Why do you feel a Project Based Learning school will be a good fit for you?

b. What will you offer the peers you work with and the community of Da Vinci Charter Academy?

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