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TIE-INS Application Form

Form Instructions

  • Before this form can be submitted all required fields must be filled in. Fields marked by a red dot are required.
  • Only enter children you wish to enroll in TIE-INS schools beginning Fall 2017. If your child is already enrolled in TIE-INS please do not continue with the online application form.
  • Only enter siblings of your children that are already enrolled in TIE-INS schools.
  • For each child or sibling all requested information must be filled out.
  • You can verify your LA Unified district status here: Find a School.
  • Disclosing your child's IEP status does not impact eligibility into the TIE-INS program. The information provided will help to ensure resources meet the individual needs of the child.
  • The form uses reCAPTCHA to prevent spam submissions; please fill out the reCAPTCHA field to successfully submit the form.

An email will be sent to you confirming your application was received. Please contact Sarah Bang at, 310-210-4633 or June Kim, 213-271-4425..

Fields marked by red dots are required.

Select your UCLA Department. Choose "Other" if your department is not listed and fill in the option below.
Enter your department if it is not listed above.
Not sure? Follow the link in the instructions above to LA Unified district maps.
Additional Parent/Grandparent/Guardian/Custodian
First Child

Enter children you wish to enroll in TIE-INS schools.

/ /
Second Child
/ /
Third Child
/ /
Fourth Child
/ /
Fifth Child
/ /
First Sibling

If your children have any siblings already enrolled in TIE-INS schools, please list them here.

Second Sibling
Third Sibling
Fourth Sibling


This field is to prevent automated submissions. If the text is difficult to read you can refresh the image using the arrow button below.



Apply for 2017-2018


If you have questions, please contact:

Zo Shay
Program Coordinator

(310) 825-8165

Sarah Bang
TIE-INS Blue Director
(310) 804-7372

June Chou Kim
TIE-INS Gold Director
(213) 271-4425