Dual Language Immersion Application Form
PLEASE NOTE: Applications submitted at this time will be placed on the waiting list.
Submission of the Dual Immersion Application Form does not guarantee placement in the Dual Immersion program.
Application for the 2014 - 2015 School Year          Application Date:   09/24/2017
If you have questions while filling out the application please call (801)826-5026.
(Items marked * are required)

Student Legal Name       First: *     Middle:     Last: *
Student Date of Birth: * (format mm/dd/yyyy) Gender: *
Current Grade Level: *(2017-2018 school year)

School for which you are applying:
(Please select a current grade)

Street: *
City: *  State: *  Zipcode: *

Child's 1st language:*  Please check here if your child is receiving services to learn English
Language spoken most often at home:*

Is your child already fluent in the language you are applying for?: *
   NOTE: Children whom are already proficient (with native-like oral proficiency) in the immersion language may receive preference in acceptance to the program. If 'Yes'' is selected, CSD may follow up with language proficiency testing. This would not apply to students that have received tutoring or lessons in a language, but is meant to target highly proficient, native-like speakers.

Has your child attended a Dual Immersion program previously?: *

Will the student(if selected) have siblings applying for a special permit to attend the traditional program?: *

Does your child have a sibling CURRENTLY enrolled in a dual immersion program at CSD?: *

Does the student have a twin/triplet also applying for the program?: *
Does your student live within the Canyons School District Boundary?: *   Not sure? Click here to find out!

Does your student currently attend a Canyons District School?: *

Guardian Information
Parent or Guardian:
    First Name: *     Last Name: *     Relationship:

Primary Phone: * (format 999-999-9999)         Secondary Phone:  (format 999-999-9999)

Email Address:               *
Confirm Email Address:*

Agreement: I have read and agree to the "Conditions for Placement in the Dual Language Immersion Program" Conditions for Placement in Dual Language Immersion Program in Canyons School District 1. If the child is accepted to attend the dual immersion program, it is the responsibility of the parents to provide transportation for the student to and from the school unless the child lives within the school boundaries. In that case, the child is eligible to ride the bus. 2. Research indicates an immersion program is most effective when students remain in the program for a sustained period of time. The student will be expected to continue with the program through 8th grade unless a team decision is made involving the parent, school staff, and district specialists that it is in the best interest of the student to be placed in another program or placement.

Please check here if you agree to the terms above

Name of Person Completing Application :