Student Enrollment Form

Phoenix Academic Center Online Registration
Please COMPLETE one application for EACH student you wish to enroll at PAC.
Please Note: A non-refundable application fee of $25 for each new student must accompany this application.
All applications are subject to approval by the PAC Board of Directors.
All new families must attend a family interview before registering for classes. APPLICATION FEES are due prior to the family interview.
Student Application

Student Information
Student Information

Information about your child.
School Year:
Grade Entering
Returning Student?

Yes No
For new students, who referred you to PAC?
Student's First Name
Student's Last Name
Student's Middle Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Student's Home Phone
Please enter a valid phone number.
Student's Cell Phone
Please enter a valid phone number.
Student's Email (this will be used by staff and teachers to communicate with your student)
example@example.com
Student's Age
Student's Birth Date

Month Day Year
Date
Student's Sex/Gender

Female Male
Does your student have any special learning needs? If so, please describe.

Parent Information
Parent/Guardian Information

Information about you.
Father's/Legal Guardian's First Name
Father's Last Name
Father's Address (if different from above. Skip otherwise.)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Father's Home Phone
Please enter a valid phone number.
Father's Cell Phone
Please enter a valid phone number.
Father's Email
example@example.com
Father's Employer
Father's Occupation
Father's Work Phone
Please enter a valid phone number.
Mother's/Legal Guardian's First Name
Mother's Last Name
Mother's Address (if different from above. Skip otherwise.)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Mother's Home Phone
Please enter a valid phone number.
Mother's Cell Phone
Please enter a valid phone number.
Mother's Email
example@example.com
Mother's Employer
Mother's Occupation
Mother's Work Phone
Please enter a valid phone number.

Siblings
Siblings

Siblings

Name

Age

School

Grade

First Sibling

Second Sibling

Third Sibling

Fourth Sibling

References
Non-Family Reference Name
Relationship
Phone Number
Please enter a valid phone number.
Family Reference Name
Relationship
Phone Number
Please enter a valid phone number.

School History

School History

Public

Private

Home

School Name

3rd Grade

4th Grade

5th Grade

6th Grade

7th Grade

8th Grade

9th Grade

10th Grade

11th Grade

Has your student ever been dismissed or suspended from an educational facility?

No Yes
Explain
Has your student ever been denied admittance to an educational facility?

No Yes
Explain

Current Educational Plans
Classes your student is planning to take at PAC for the upcoming academic year. If you need to enroll more than four classes, please contact us.
Class 1
Class 2
Class 3
Class 4
Other classes your student will be attending and/or that you are planning to teach at home for the upcoming academic year. Please describe each class, it's name, subject, curriculum, and who the class is to be taught by. If more than four, please used the "Additional" text box at the end to describe the remaining classes.
Class 1
Class 2
Class 3
Class 4
Describe any additional classes, subject, curriculum, and teacher.

Finishing Up and Submitting Your Application
Describe your reasons and expectations for enrolling this student at PAC.
PAC is an educational center, not a school. We are structured to assist families who are committed to the concepts of Christian self-government and home schooling. This means that students are responsible for their own behavior and learning under the guidance of a parent or teacher. Please rate this student’s ability and willingness to function in such an environment using a one (1) to three (3) scale. One (1) is low, two (2) is average and three (3) is high.

Type a question

Low

Average

High

Shows respect to and for authority

Listens to and obeys instructions

Completes assignments on time

Prompt

Works quietly and independently

Resists negative peer pressure

Willing to follow rules and regulations

Avoids excessive absences/tardiness

Is there any other information about this student or your family that would be helpful?
If you are done, go ahead and submit the form. If you need more time, you can save your form and come back to it later. You will receive an email with a link to your partially completed form.
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Phoenix Academic Center Online Registration

Student Application

Student Information

Parent/Guardian Information

Siblings