Silvies River Student Application

Silvies River Charter School Student Application
Only fill out this form if you are interested in applying for our school. Please make sure your contact information is accurate so we can contact you. When you fill out the form our enrollment specialist will give you a follow up phone call to ensure your interest and verify your information.
YES - I am a PREVIOUS studentYES - I am a CURRENT studentNO - I have NEVER attended SRCS
In the Current School Year - 25/26In the Next School Year - 26/27
First and Last Name of Applicant Student*

First NameLast Name
Enter student's Legal Middle name.
Enter Student's Date of Birth*

MonthDayYear
MFNon-Binary
Hispanic or LatinoNot Hispanic or Latino
WhiteBlackNative AmericanPacific IslanderAsian
EnglishSpanishRussianChineseJapaneseOther
STREET Address - Please enter the physical address where this student resides.*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
YESDifferent Address
Mailing address - Please enter address for receiving mail here.*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone for this applicant*
Format: 000-000-0000.
YESNO
Student's Cell Phone Number
Format: 000-000-0000.
YESNO
Student's eMail address
Please complete as fully as possible
Which School District do you currently reside in
School District where you currently reside*
Select district name from pull down list. If unknown select 'I Do Not Know'...
YESNO
25/2624/2523/2422/23Never AttendedOther
Attending a public K-12 schoolAttending a private K-12 schoolHome School - RegisteredHome School - Not RegisteredAttending a Virtual School
Last Grade Attended*
Select from list
What Grade Level are you requesting to enroll in at this time*
Select from list
Last School Attended - Name
Name of School
Last School Attended - Location
City and State
Special Education (IEP)504 PlanEnglish as a 2nd LanguageMigrant ServicesPhysical Therapy ServicesSpeech and Hearing Services
When and Where Please provide any information you may have about when you last met with a school official and from what school these services were provided.
NOYES
If Yes. What is the sibling's name
Both ParentsMotherFatherGrandparent(s)StepparentGuardian / Foster ParentAlone
YESNO
What is the primary eMail address to be used for contacting this applicant's parent(s)*
YESNO
Parent 1 Information
Parent 1 Relationship to Applicant Student
Parent 1 Name

First NameLast Name
Home PhoneCell PhoneWork PhoneNone
Parent 1's Home Phone Number
Format: 000-000-0000.
FParent 1's Cell Phone Number
Format: 000-000-0000.
Parent 1's Work Phone Number
Format: 000-000-0000.
SameDifferent
Parent 1's eMail
YESNO
Parent 1's Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent 2 Information
YESNO
Parent 2's Relationship to Applicant Student
Parent 2's Name

First NameLast Name
Home PhoneCell PhoneWork PhoneNone
Parent 2's Home Phone Number
Format: 000-000-0000.
Parent 2's Cell Phone Number
Format: 000-000-0000.
Parent 2's Work Phone Number
Format: 000-000-0000.
SameDifferent
Parent 2's eMail
YESNO
Parent 2's Mailing Address.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Alternate / Emergency Contact
Alternate Contact NAME: Please provide the name of a primary alternate or emergency contact for this student. (Close friend / Relative etc)*
Alternate Contact PHONE*
Other Information: Please enter any other comments and or questions that you might have which would help the registrar and counselor in evaluation of this application.
Recommended by a friendRecommended by a school counselorFrom your web siteFrom an add in a local paperFrom a printed flyerFrom FaceBook
Enter Student's Date of Birth*
Enter as MM/DD/YYYY
MonthDayYear
Should be Empty:

Silvies River Charter School Student Application

Only fill out this form if you are interested in applying for our school. Please make sure your contact information is accurate so we can contact you. When you fill out the form our enrollment specialist will give you a follow up phone call to ensure your interest and verify your information.

Please complete as fully as possible

Parent 1 Information

Parent 2 Information

Alternate / Emergency Contact