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Full Time
Application Form

This form should be submitted during the application period, February 1 to April 30, to be considered for enrollment for the next school year.  Notification of application status will be received via email on May 15 of each year.

STUDENT DEMOGRAPHICS
First Name
 		 Middle Initial
 		 Last Name
 		 Date of Birth mm/dd/yyyy
 		 Gender
Male Female
Address
 		 City
 		 State
 Zip
 
Email Address
 		 Preferred  Phone
 		  Alternate Phone
 Graduating Class Of
 
PARENT INFORMATION
First Name
 		 Last Name
 		 Preferred Phone
 		 Alternate Phone
 Work Phone
Parent E-Mail Address
 City
 		 State
 		 Zip
 
RESIDENT DISTRICT
Name of School District (resident)
 		 Contact Person
 		 Phone
 
Address
 		 City
 		 State
 Zip
 
COURSE REQUEST INFORMATION
I request the following course(s) to be taken during the upcoming school year:
Course #1

  Note: 

Course #2    Note:
Course #3     Note:
Course #4     Note:
Course #5     Note:
Course #6     Note:
 
APPROVAL
Student Signature
 		 Date mm/dd/yyyy
 		 Parent Signature
 		 Date
 mm/dd/yyyy
by checking this box you have created an electronic signature as legally binding as your handwritten signature  

District Representative Signature                      School Code

                                 

 



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