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THE SCHOOL DISTRICT OF PALM BEACH COUNTY
DEPARTMENT OF CHOICE AND CAREER OPTIONS
Online application is preferred.
Save time, money, and receive an
immediate confirmation email. Complete the
online application at:
www.mypbchoiceapp.com
Choice Programs Application
School Year 2015-2016
CHECK ONE ONLY
Elementary
Middle
OFFICE USE ONLY
Assigned SAC School
SAC #
High School
Deadlines: December 12, 2014 for Bak MSOA, A.W. Dreyfoos Jr SOA, Boynton Beach High School Arts Programs, and The
Conservatory School @ North Palm Beach. Deadline of January 30, 2015 for all other schools.
Incomplete or faxed applications will NOT be accepted.
Read the information on Page 2 before completing application. ONE application per child may be submitted. Parent/guardian
and student must be full-time residents of Palm Beach County on date of submission. Falsification of information on this
application could lead to ineligibility. For more information, call (561) 434-8755. Type or print legibly in blue or black ink and return
completed application to: Department of Choice and Career Options 3300 Forest Hill Blvd., C-124, West Palm Beach, FL 33406.
Student Name (first, middle, last)
Gender
F
Student ID #
Birth Date (mm/dd/yy)
M
/
Name of Parent(s)/Legal Guardian(s)
Current Grade
Grade Applying For
Current School
/
Race (check at least one)
Ethnic Origin (check one)
Hispanic or Latino
NOT Hispanic or Latino
Black/Non Hispanic
American Indian/Alaskan Native
Multiracial
Asian/Pacific Islander
White/Non Hispanic
HOME ADDRESS MUST MATCH ADDRESS ON FILE AT SCHOOL or application will NOT be processed.
Home Address
Home Phone No.
City
Cell Phone No.
Zip Code
Parent/Guardian E-mail Address
STRAND Has the applicant participated in and completed a program in a similar preparatory choice theme in grades 4-5 or
grades 7-8? If yes, provide name of school and program:
Yes
No
SIBLINGS Siblings are defined as brother, sister, half-brother, half-sister, stepbrother, or stepsister, living in the same household.
Name of one (1) sibling who is already attending and will be attending the same Choice school to which this applicant is applying:
NAME OF SIBLING
SCHOOL
PROGRAM
SIBLING(S) APPLYING Name of sibling(s) currently applying to the same Choice school as this applicant:
BIRTH DATE
GRADE
Check if siblings are twins or triplets.
MILITARY Is parent active military or full-time Reserves? (Documentation required)
Go to www.palmbeachschools.org/choiceprograms for required documentation (PBSD 2473).
Yes
No
EMPLOYEE If parent/guardian is a full-time employee at the school selected as your first choice preference, the Principal must verify this employment
by signing below.
Signature of School Principal
Name of School
Date
SIGNATURE - I have read, understand and agree to the following:
1. I have read (or had read to me), understand, and had an opportunity to ask questions about the information provided in the
2015-2016 Choice booklet and the "Procedures Manual" for Choice programs, both of which are available online at
www.palmbeachschools.org/choiceprograms.
2. I understand that ONLY ONE (1) Choice application per student may be submitted and only one application selection change will
be allowed if applying online.
3. I understand that I must provide my child's IEP, ELL, or 504 Plan prior to an audition to ensure the accommodations are provided.
4. I understand that if my child is not selected for the 2015-2016 school year, a new application must be submitted for the following
school year.
5. Acceptance of a Choice program takes the place of all assignments for other programs including but not limited to: Reassignment,
Opportunity Scholarships, and students currently enrolled in a school through NCLB.
6. My signature verifies that I declare, under penalties of perjury,
pursuant to Florida Statute, Section 92.525, that I have read this
application, including all sections on Page 2, and all the information
stated in this application is true and correct.
PBSD 1537 (Rev. 11/3/2014)
Signature of Parent/Guardian
ORIGINAL - Department of Choice Programs and School Choice
Date
Page 1 of 8
Student Name
Choice Programs Application
School Year 2015-2016
Apply online at www.mypbchoiceapp.com
DIRECTIONS Current PBCSD students must include Student ID on the application. Students applying for kindergarten must be 5
years old by September 1, 2015. Indicate your first and second program choices by placing a "1" for your first preference and a "2" for
your second preference in the columns marked "#". Only two program choices are permitted. Eligibility criteria for Choice programs
are indicated in the 2015-2016 Choice booklet located at http://www.palmbeachschools.org/choiceprograms. Review the
eligibility criteria prior to selection. Identification of a second choice does not decrease a student's chances of being selected to the
first choice. First and second choices do not have equal chances of being selected. Programs may have limited numbers of available
seats and may not have any second choice students assigned in the lottery. Completion of this application does not guarantee
admission.
HOME EDUCATION, VIRTUAL SCHOOLS AND PRIVATE SCHOOLS Parents must submit transcripts/portfolio to applicant
school(s) for determination of eligibility. Check the eligibility criteria as indicated on pages 5 and 6 in the Choice booklet 2015-2016.
MONTESSORI Northboro Elementary and S.D.Spady Elementary accept applications for Pre-K students. D.D. Eisenhower
Elementary accepts applications for K-5. For Northboro Elementary and S.D. Spady Elementary Pre-K3, applicants must be 3 years
old by September 1, 2015 and Pre-K4, applicants must be 4 years old by September 1, 2015.
AUDITIONS - Bak MSOA, A.W. Dreyfoos Jr. SOA, Boynton Beach High School Arts programs, and The Conservatory School @
North Palm Beach In order to be eligible for the Choice lottery, the student must receive an eligible audition score for Bak Middle
School of the Arts, A.W. Dreyfoos Jr. School of the Arts, and Boynton Beach High School Arts programs. Students applying for The
Conservatory School @ North Palm Beach (grades 6-7) must participate in scheduled Instrumental Music Jury Assessment (IMJA).
Approved applicants will be notified via email and/or U.S. Mail of the audition procedures and/or time and date of student audition.
Applicants who need special accommodations or translations during audition(s) should contact the Choice Coordinator at Bak MSOA,
(561) 882-3801/(561) 882-3819, at Dreyfoos SOA (561) 802-6005, at Boynton Beach High School (561) 752-1200, or at The
Conservatory School @ North Palm Beach (561) 494-1844.
APPEALS Parents who believe their child was not allowed an equitable opportunity to a Choice program during the audition or
eligibility process as a result of a technical problem or inequity may request an appeal after April 3, 2015. An application for an appeal
of Choice program eligibility must be submitted to the Director of Choice and Career Options within ten school days from the date of the
lottery notification letter. To download the Application for Appeal, go to www.palmbeachschools.org/ Forms/Documents/2418.pdf after
April 3, 2015
DUPLICATE PROGRAMS If the student is applying for a Choice program that is also offered at his/her home school, the home school
program must be listed as the first choice or the application will not be processed, with limited exceptions. All students may apply for
first choice to the following full choice schools: Suncoast HS, A.W. Dreyfoos Jr. SOA, Don Estridge High Tech MS, Bak MSOA,
Morikami Park ES, Northboro ES, Poinciana ES, SD Spady ES, and Village Academy. All students may apply for first choice to
Boynton Beach High School Arts programs (Dance, Digital Media, Music-Band, Music- Keyboard/Piano, Music-Vocal, Theatre, and
Visual Arts). Check the 2015-2016 Choice booklet for eligibility criteria on pages 5 and 6 to help determine your choices.
TRANSPORTATION Choice program students receive transportation to a Choice school if they reside more than two miles from the
school and live within a designated Choice Transportation Zone. (See the District transportation website: www.palmbeachschools.org/
transportation). Bus stops to Choice schools or programs may be limited and located significantly farther from the student's home than
transportation to student's home school. Students who live outside the Choice Transportaton Zone may attend the Choice school if
they provide their own transportaton to and from the school or to the nearest school bus pick-up location within the Choice
Transportation Zone. Available bus stops are listed online at www.palmbeachschools.org/transportation.
PBSD 1537 (Rev. 11/3/2014)
ORIGINAL - Department of Choice Programs and School Choice
Page 2 of 8
Pre-K & ELEMENTARY SCHOOLS 2015-2016
#
Student Name
PROGRAM
SCHOOL
LOCATION
Biomedical and Veterinary Technology
Acreage Pines
Loxahatchee
Health and Wellness
Allamanda
Palm Beach Gardens
Technology
Boca Raton
Boca Raton
Spanish Dual Language
Cholee Lake
Greenacres
International Baccalaureate Primary Years Programme
Dr. Mary McLeod Bethune
Riviera Beach
Montessori (K-5)
D.D. Eisenhower
Palm Beach Gardens
International Baccalaureate Primary Years Programme
Forest Park
Boynton Beach
Environmental and Animal Science
Frontier
Loxahatchee
E3-Energy, Environment, and Engineering
Galaxy
Boynton Beach
Visual, Performing & Communication Arts
Glade View
Belle Glade
Technology
Golden Grove
West Palm Beach
Spanish Dual Language
Gove
Belle Glade
Spanish Dual Language
Hagen Road
Boynton Beach
International Baccalaureate Primary Years Programme
Morikami Park
Delray Beach
International Spanish Academy (ISA)
New Horizons
Wellington
Spanish Dual Language
North Grade
Lake Worth
Montessori (Pre-K3, Pre-K4, K-5)
Northboro
West Palm Beach
International Baccalaureate Primary Years Programme
Pahokee
Pahokee
Science, Technology, Engineering, Arts and Math (STEAM)
Palm Beach Gardens
Palm Beach Gardens
Orchestral Strings
Palm Beach Public
Palm Beach
Science (Environmental), Technology, Engineering and Math
Pine Jog
West Palm Beach
Spanish Dual Language
Plumosa School of the Arts (SOA)
Delray Beach
Science, Technology, Engineering and Math
Poinciana
Boynton Beach
Math, Science and Technology
Roosevelt
West Palm Beach
Montessori (Pre-K3, Pre-K4, K-5)
S.D. Spady
Delray Beach
Health and Wellness
Starlight Cove
Children's Orchestra and Performing Arts Project (COPA)
The Conservatory School
@ North Palm Beach
North Palm Beach
Visual, Performing and Communication Arts
U.B. Kinsey/Palmview SOA
West Palm Beach
Small School Continuum
Village Academy
Delray Beach
International Baccalaureate Primary Years Programme
Westward
West Palm Beach
Visual, Performing & Communication Arts
PBSD 1537 (Rev. 11/3/2014)
ORIGINAL - Department of Choice Programs and School Choice
Lantana
Page 3 of 8
MIDDLE SCHOOLS 2015-2016
#
Student Name
PROGRAM
SCHOOL
LOCATION
Communication Arts
Bak Middle School of the Arts
West Palm Beach
Pre-Biotechnology
Bear Lakes
West Palm Beach
Math
Boca Raton
Boca Raton
Carver
Delray Beach
Congress
Boynton Beach
Conniston
West Palm Beach
High Technology
Don Estridge High Tech Middle
Boca Raton
Pre-Engineering (Gateway to Technology)
Eagles Landing
Boca Raton
Math, Science & Robotics
H.L. Watkins
Palm Beach Gardens
Independence
Jupiter
Pre-Law
Jeaga
West Palm Beach
International Baccalaureate Middle Years Programme
John F. Kennedy
Riviera Beach
Multimedia, Music and Communications
Jupiter
Jupiter
Pre-Information Technology
L.C. Swain
Greenacres
Pre-Medical Sciences
Lake Shore
Belle Glade
Biomedical Sciences (FAU College of Medicine)
Lake Worth
Lake Worth
Lantana
Lantana
Loggers' Run
Boca Raton
Okeeheelee
Greenacres
Dance
Music - Band
Instrument:
Music - Keyboard/Piano
Music - Orchestral Strings
Instrument:
Music - Vocal
Theatre
Visual Arts
Pre-Medical Sciences
International Baccalaureate Middle Years Programme
Pre-Information Technology
Digital Graphic Design
Digital Video Design
Pre-Engineering
Pre-Medical Sciences
International Baccalaureate Middle Years Programme
Spanish Dual Language
Pre-Medical Sciences
Pre-Business/IT
Pre-Law
Pre-Medical Sciences
Pre-Teacher Education
Pre-Culinary Arts
Pre-Information Technology
Pre-Law
Pre-Medical Sciences
Pre-Engineering (Gateway to Technology)
Band
Dance
Pre-Medical Sciences
Pre-Teacher Education
Pre-Culinary
Pre-Law
Pre-Medical Sciences
International Spanish Academy (ISA)
PBSD 1537 (Rev. 11/3/2014)
ORIGINAL - Department of Choice Programs and School Choice
Page 4 of 8
MIDDLE SCHOOLS 2015-2016
#
Student Name
PROGRAM
SCHOOL
LOCATION
Pre-Culinary Arts
Osceola Creek
Loxahatchee
International Baccalaureate Middle Years Programme
Pahokee
Pahokee
Communications Arts
Palm Springs
West Palm Beach
Pre-Veterinary
Dance
Music - Band
Music - Orchestral Strings
Music - Vocal
Spanish Dual Language
Theatre
Visual Arts
Biomedical Sciences (FAU College of Medicine)
Roosevelt
West Palm Beach
Environmental Science / GIS
Leadership Academy for Young Men
Pre-Engineering
Pre-Medical Sciences
Technology
Symphony Orchestra (Grades 6-7)
Pre-Culinary Arts
The Conservatory School
@ North Palm Beach
North Palm Beach
Tradewinds
Greenacres
Small School Continuum
Village Academy
Delray Beach
Literary and Fine Arts - Instrumental
Watson B. Duncan
Palm Beach Gardens
Pre-Information Technology
Wellington Landings
Wellington
Graphic Arts
Western Pines
Royal Palm Beach
Woodlands
Lake Worth
Pre-Teacher Education
Literary and Fine Arts - Theatre
Literary and Fine Arts - Visual
Literary and Fine Arts - Vocal
Literary and Fine Arts - Writing & Literature
Pre-Finance
Pre-Information Technology
Pre-Medical Sciences
Pre-Information Technology
PBSD 1537 (Rev. 11/3/2014)
ORIGINAL - Department of Choice Programs and School Choice
Page 5 of 8
HIGH SCHOOLS 2015-2016
#
Student Name
PROGRAM
SCHOOL
LOCATION
Communication Arts
A.W. Dreyfoos Jr.
School of the Arts
West Palm Beach
Atlantic
Delray Beach
Navy Junior ROTC
Boca Raton
Boca Raton
Aerospace Science (BASA)
Boynton Beach
Boynton Beach
Forest Hill
West Palm Beach
Glades Central
Belle Glade
John I Leonard
Greenacres
Jupiter
Jupiter
Lake Worth
Lake Worth
Dance
Digital Media
Music - Band
Instrument:
Music - Keyboard/Piano
Music - Strings
Instrument:
Music - Vocal
Theatre
Visual Arts
International Baccalaureate
International Baccalaureate Medical Sciences
Dance
Digital Media
Information Technology
Music - Band Instrument:
Music - Keyboard/Piano
Music - Vocal
Theatre
Visual Arts
Army Junior ROTC
Engineering & Technology (PLTW)
Environmental Science & Field Research
Information Technology
International Baccalaureate Diploma Programme
Tourism, Hospitality and Resort Management
Criminal Justice
Engineering & Technology
Medical Sciences - Pre-Medicine
Computer Technology
Finance
International Spanish Academy (ISA)
Medical Sciences - Pre-Medicine
Engineering & Technology (PLTW)
Environmental Science and Field Research
Medical Sciences - Pre-Medicine
Air Force Junior ROTC
Biomedical Sciences (FAU College of Medicine)
Criminal Justice
Culinary Arts
Drafting & Design
Early Childhood Teacher Education
Medical Sciences - Pre-Medicine
PBSD 1537 (Rev. 11/3/2014)
ORIGINAL - Department of Choice Programs and School Choice
Page 6 of 8
HIGH SCHOOLS 2015-2016
Student Name
PROGRAM
SCHOOL
LOCATION
Early Childhood Teacher Education
Olympic Heights
Boca Raton
Pahokee
Pahokee
Palm Beach Central
Wellington
Palm Beach Gardens
Palm Beach Gardens
Palm Beach Lakes
West Palm Beach
Park Vista
Lake Worth
Royal Palm Beach
Royal Palm Beach
Santaluces
Lantana
Seminole Ridge
Loxahatchee
Spanish River
Boca Raton
Suncoast
Riviera Beach
Village Academy
Delray Beach
Engineering & Technology (PLTW)
Finance
Tourism, Hospitality & Resort Management
Air Force Junior ROTC
Information Technology
International Baccalaureate
Teacher Education
Culinary Arts
Engineering & Technology (PLTW)
Web and Digital Design
Biomedical Sciences (FAU College of Medicine)
Culinary Arts
Global Business and Entrepreneurship
Medical Sciences - Pre-Medicine
Sports Management & Recreation
Television & Film Production Technology
Tourism, Hospitality & Resort Management
Biotechnology
Center for Pre-Law/Law Related Careers
Early Childhood Teacher Education
Medical Sciences - Pre-Medicine
Teacher Education
Auto Collision Repair and Refinishing
Automotive Service Technology
Medical Sciences - Pre-Medicine
Air Conditioning, Refrigeration & Heating Technology
Global Business
Medical Sciences - Pre-Medicine
Science, Technology, Engineering and Mathematics
Band/Music Industry
Culinary Arts
Early Childhood Teacher Education
Visual Arts (Digital Media & Photography)
Biotechnology
Construction
Television and Film Production Technology
American History & Law
Biotechnology
Entrepreneurship
Computer Science
Innovative Interactive Technology
International Baccalaureate
Mathematics, Science & Engineering
Small School Continuum
PBSD 1537 (Rev. 11/3/2014)
ORIGINAL - Department of Choice Programs and School Choice
Page 7 of 8
HIGH SCHOOLS 2015-2016
#
Student Name
PROGRAM
SCHOOL
LOCATION
Equine/Pre-Veterinary
Wellington
Wellington
West Boca Raton
Boca Raton
William T. Dwyer
Palm Beach Gardens
Fire Science
Marketing
Culinary Arts
Drafting & Design
Information Technology
Medical Sciences - Pre-Medicine
Early Childhood Teacher Education
Finance
International Baccalaureate
PBSD 1537 (Rev. 11/3/2014)
ORIGINAL - Department of Choice Programs and School Choice
Page 8 of 8