Clarksville Charter - Open Enrollment (2021-22)

Clarksville Charter | Open Enrollment 2021-2022

Please only submit one form per household, and only enroll new students through this form.
Clarksville Charter Enrollment Timeline
Parent / Guardian Information
Name *

First Name Last Name
E-mail *

Confirmation Email example@example.com
Primary Phone *
County of Residence *
We will verify this later via your Proof of Residence document.
Address *

Street Address

Street Address Line 2

City State

Zip Code
Alternate Contact Full Name *
We will only reach out if we cannot reach you through the primary email & phone.
Relationship to Student *
Alternate Contact Phone *
Teacher Request *
Teacher Full Name *
Qualifying Preference Category *
Sibling District ID *
You can locate your student's District ID via the Parent Portal or EOS.
Staff Email *
Please enter your school email. Normal emails like @Gmail will be rejected.
How many NEW students do you want to enroll? *
DO NOT count students who are currently enrolled for the 2020-21 school year.
Student 1: Information

Please only enter information for NEW students.
Student Name *

First Name Last Name
Date of Birth *

Month Day Year
Grade in School 2021-22 *
Student 2: Information

Please only enter information for NEW students.
Student Name *

First Name Last Name
Date of Birth *

Month Day Year
Grade in School 2021-22 *
Student 3: Information

Please only enter information for NEW students.
Student Name *

First Name Last Name
Date of Birth *

Month Day Year
Grade in School 2021-22 *
Student 4: Information

Please only enter information for NEW students.
Student Name *

First Name Last Name
Date of Birth *

Month Day Year
Grade in School 2021-22 *
Student 5: Information

Please only enter information for NEW students.
Student Name *

First Name Last Name
Date of Birth *

Month Day Year
Grade in School 2021-22 *
Student 6: Information

Please only enter information for NEW students.
Student Name *

First Name Last Name
Date of Birth *

Month Day Year
Grade in School 2021-22 *
Terms and Conditions
Today's Date *

Month Day Year
Date
Checking 'I Agree' and signing below, you declare under penalty of perjury under the laws of California that you are the Parent or Guardian of the above student(s). By submitting an application, you agree to the storage of their personal details, in Clarksville Charter School's administrative systems, whether on paper, computer, or any other medium, and to the usage of that information for Clarksville Charter School's purposes only. Ed Code § 47605(e)(4) Charter School Notice and Form
*

I Agree
Signature *
Should be Empty:

Clarksville Charter | Open Enrollment 2021-2022

Parent / Guardian Information

Student 1: Information

Student 2: Information

Student 3: Information

Student 4: Information

Student 5: Information

Student 6: Information

Terms and Conditions