Re-Enrollment Form

Please complete the form below. Required fields marked with an asterisk *

Student First Name*

Answer Required

Student Last Name*

Answer Required

Student Date of Birth*

Answer Required

Student's current grade*

Answer Required

Grade 5

Grade 6

Grade 7

Street Address*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

Phone Number*

Number Required

Parent/Guardian Names*

Answer Required

Email Address*

Answer Required

Does the student have a sibling applying to RAPCS?*

Answer Required

Yes

Sibling Name

Answer Required

Grade Sibling Applying To

Answer Required

Grade 5

Grade 6

Grade 7

Grade 8

By checking this box in the affirmative, I certify that the information given is true and correct to the best of my knowledge. I also certify that I am legally able to enroll this student in school.*

Answer Required

I agree with the above statement

Option

The charter school will not discriminate against any applicant for employment or admission, in any way that is illegal based on Pennsylvania Law or Pennsylvania Department of Education standards, including race, religion, gender, age, status as a person with a disability, proficiency in the English language, or academic aptitude.

Submitted On*

Answer Required

Please fix the highlighted areas below before submitting.

Re-Enrollment Form