Application | Drush Site-Install

Student Information

First Name

Middle Name

Last Name

Date of Birth

Gender

Grade Applying For

Street Address

City

State

ZIP Code

Parent/Guardian Information

Parent/Guardian 1 - First Name

Last Name

Relationship to Student

Email Address

Primary Phone Number

Secondary Phone Number

Parent/Guardian 2 - First Name

Last Name

Relationship to Student

Email Address

Phone Number

Emergency Contact Information

Emergency Contact Name

Relationship to Student

Phone Number

Alternate Phone Number

Previous School Information

Is the student currently enrolled in school?

Yes

Current/Previous School Name

School District

City

State

Current Grade Level

Medical and Special Needs Information

Does the student have any medical conditions we should be aware of?

Yes

Please describe

Does the student have any allergies?

Yes

Please list allergies

Current Medications

Please list any medications the student takes regularly

Does the student have an IEP or 504 Plan?

Yes

Please provide details

Special Accommodations or Support Services Needed

Additional Information

Will the student require school transportation?

Yes

Would you like to apply for free or reduced lunch?

Yes

Already qualified at current school

Student Interests and Activities

Please tell us about your child's interests, hobbies, and extracurricular activities

Why are you interested in our charter school?

Required Documents

Agreement

Parent/Guardian Full Name (Electronic Signature)

Date

I certify that all information provided is accurate and complete