Pinecrest Academy South Charter School
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Student Information
Incoming Grade Level
*
Select
K
1st
2nd
3rd
4th
5th
Student First Name
*
Student Middle Name
Student Last Name
*
Incoming School Year
*
Select
2023-2024
2024-2025
Student Date of Birth
*
Sex
*
Select
Male
Female
Has the student ever attended public school?
*
Select
Yes
No
Name of School or Preschool the Student is Currently Attending
*
If not applicable, enter "N/A" above.
Current Student ID
*
If not known, enter "Unknown".
Student Address 1
*
Student Address 2
City
*
State
*
Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
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Parent/Guardian Information
Parent/Guardian 1 First Name
*
Parent/Guardian 1 Last Name
*
Parent/Guardian 1 Email
*
Parent/Guardian 1 Phone Number
*
Parent/Guardian 1 Alternate Phone Number
Is there a second Parent/Guardian you would like to enter?
*
Select
Yes
No
If a second parent or guardian is not applicable, please enter N/A below.
Parent/Guardian 2 First Name
*
Parent/Guardian 2 Last Name
*
Parent/Guardian 2 Email
*
Parent/Guardian 2 Phone Number
*
Parent/Guardian 2 Alternate Phone Number
Is any parent/guardian of this student active in the military?
Select
Yes
No
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Additional Information
Is the student a sibling of a current student?
*
Select
Yes
No
By selecting
Yes
above, you are confirming that the student you are applying for has a sibling who
already
attends the school.
Sibling First Name
*
Sibling Last Name
*
Sibling Student ID#
*
If not known, enter “Unknown”.
Sibling Grade Level
*
Select
PK
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Do you have any other school age siblings for whom you are submitting applications?
*
Select
Yes
No
Please note: In addition to listing student siblings below, You must submit a
new
application for each sibling you wish to apply for.
Number of Additional Sibling Applicants
1
2
3
4
5
How did you learn about our school?
*
Select
Driving By
Community Event
Email
Facebook
Other Social Media
Search Engine
US Mail
Television
Website
Word of Mouth – Referido por familia/Amistad
What interested you in our school?
*
Signature of Parent/Guardian who Filled Out Application
*
Clear Signature
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