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.
HAVE YOU EVER PREVIOUSLY BEEN ENROLLED AS A STUDENT WITH SILVIES RIVER CHARTER SCHOOL OR ARE YOU CURRENTLY A STUDENT WHO IS APPLYING FOR CONTINUED ENROLLMENT IN A NEW YEAR
*
YES - I am a PREVIOUS student
YES - I am a CURRENT student
NO - I have NEVER attended SRCS
WHEN WOULD YOU LIKE THIS REQUESTED ENROLLMENT TO BEGIN
*
In the Current School Year - 23/24
Next School Year - 24/25
First and Last Name of Applicant Student
*
First Name
Last Name
Enter student's Legal Middle name.
Enter Student's Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Gender
*
M
F
Non-Binary
Ethnicity
*
Hispanic or Latino
Not Hispanic or Latino
Race New federal regulations require that we report Race as well as Ethnicity. Select at least one response (you may select more than one as appropriate)
*
White
Black
Native American
Pacific Islander
Asian
Language Spoken at Home (Language of Origin)
*
English
Spanish
Russian
Chinese
Japanese
Other
STREET Address - Please enter the physical address where this student resides.
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Mail Address - Does student receive US Mail at the above address?
YES
Different Address
Mailing address - Please enter address for receiving mail here.
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Home Phone for this applicant
*
Does the student have their own Cell Phone?
YES
NO
Student's Cell Phone Number
Does the student have their own eMail Address ( If same as Parent, Check NO )
YES
NO
Student's eMail address
Please complete as fully as possible
Which School District do you currently reside in
School District where you currently reside
*
I Do Not Know
Adel SD 21
Adrian SD 61
Albany Public SD 8J
Alsea SD 7J
Amity SD 4J
Annex SD 29
Arlington SD 3
Arock SD 81
Ashland SD 5
Ashwood SD 8
Astoria SD 1
Athena-Weston SD 29RJ
Baker SD 5J
Bandon SD54
Banks SD 13
Beaverton SD 48J
Bend-La Pine Admin SD 1
Bethel SD 52
Blachly SD 90
Black Butte SD 41
Brookings-Harbor SD 17C
Brothers SD 15
Burnt River SD 30J
Butte Falls SD 91
Camas Valley SD 21J
Canby SD 86
Cascade SD 5
Centennial SD 28J
Central Curry SD 1
Central Linn SD 552
Central Point SD 6
Central SD 13J
Chenowith SD 9
Clatskanie SD 6J
Colton SD 53
Condon SD 25J
Coos Bay SD 9
Coquille SD 8
Corbett SD 39
Corvallis SD 509J
Cove SD 15
Creswell SD 40
Crook County SD
Crow-Applegate-Lorane SD 66
Culver SD 4
Dallas SD 2
David Douglas SD 40
Dayton SD 8
Dayville SD 16J
Diamond SD 7
Double O SD 28
Douglas County SD 15
Douglas County SD 4
Drewsey SD 13
Dufur SD 29
Eagle Point SD 9
Echo SD 5
Elgin SD 23
Elkton SD 34
Enterprise SD 21
Estacada SD 108
Eugene SD 4J
Falls City SD 57
Fern Ridge SD 28J
Forest Grove SD 15
Fossil SD 21J
Frenchglen SD 16
Gaston SD 511J
Gervais SD 1
Gladstone SD 115
Glendale SD 77
Glide SD 12
Grants Pass SD 7
Gresham-Barlow SD 10J
Harney County SD 3
Harney County SD 4
Harney County Union High SD 1J
Harper SD 66
Harrisburg SD 7J
Helix SD 1
Hermiston SD 8
Hillsboro SD 1J
Hood River County SD
Huntington SD 16J
Imbler SD 11
Ione SD R2
Jefferson County SD 509J
Jefferson SD 14J
Jewell SD 8
John Day SD 3
Jordan Valley SD 3
Joseph SD 6
Junction City SD 69
Juntura SD 12
Klamath County SD
Klamath Falls City Schools
Knappa SD 4
La Grande SD 1
Lake County SD 7
Lake Oswego SD 7J
Lebanon Community SD 9
Lincoln County SD
Long Creek SD 17
Lowell SD 71
Malheur County SD 51
Mapleton SD 32
Marcola SD 79J
McKenzie SD 68
McMinnville SD 40
Medford SD 549C
Milton-Freewater Unified SD 7
Milton-Freewater Unified SD 7
Mitchell SD 55
Molalla River SD 35
Monroe SD 1J
Monument SD 8
Morrow SD 1
Mt Angel SD 91
Myrtle Point SD41
Neah-Kah-Nie SD 56
Nestucca Valley SD 101J
Newberg SD 29J
North Bend SD 13
North Clackamas SD 12
North Douglas SD 22
North Lake SD 14
North Marion SD 15
North Powder SD 8J
North Santiam SD 29J
North Wasco County SD 21
Nyssa SD 26
Oakland SD 1
Oakridge SD 76
Ontario SD 8C
Oregon City SD 62
Oregon Trail SD 46
Paisley SD 11
Parkrose SD 3 attn Susan Fox
Pendleton SD 16
Perrydale SD 21
Philomath SD 17J
Phoenix-Talent SD 4
Pilot Rock SD 2
Pine Creek SD 5
Pine Eagle SD 61
Pinehurst SD 94
Pleasant Hill SD 1
Plush SD 18
Port Orford-Langlois SD 2CJ
Portland SD 1J
Powers SD 31
Prairie City SD 4
Prospect SD 59
Rainier SD 13
Redmond SD 2J
Reedsport SD 105
Reynolds SD 7
Riddle SD 70
Riverdale SD 51J
Rogue River SD 35
Salem-Keizer
Santiam Canyon SD 129J
Scappoose SD 1J
Scio SD 95
Seaside SD 10
Sheridan AllPrep
Sheridan SD 48J
Sherman County SD
Sherwood SD 88J
Silver Falls SD 4J
Sisters SD 6
Siuslaw SD 97J
South Harney SD 33
South Lane SD 45J3
South Umpqua SD 19
South Wasco County SD 1
Spray SD 1
Springfield SD 19
St Helens SD 502
St Paul SD 45
Stanfield SD 61
Suntex SD 10
Sutherlin SD 130
Sweet Home SD 55
The Dalles SD 12
Three Rivers/Josephine County SD
Tigard-Tualatin SD 23J
Tillamook SD 9
Troy SD 54
Ukiah SD 80R
Umatilla SD 6R
Union SD 5
Vale SD 84
Vernonia SD 47J
Wallowa SD 12
Warrenton-Hammond SD 30
West Linn-Wilsonville SD 3J
Willamina
Winston-Dillard SD 116
Woodburn SD 103
Yamhill-Carlton SD 1
Yoncalla SD 32
Select district name from pull down list. If unknown select 'I Do Not Know'...
Are you currently enrolled and attending school in any way including home school
*
YES
NO
In what school year did you last attend
*
20/21
19/20
19/20 But Withdrew
18/19
17/18
16/17
Never Attended
Other
What best describes your current school status
*
Attending a public K-12 school
Attending a private K-12 school
Home School - Registered
Home School - Not Registered
Attending a Virtual School
Last Grade Attended
*
Please Select
N/A
KG
01
02
03
04
05
06
07
08
09
10
11
12
Select from list
What Grade Level are you requesting to enroll in at this time
*
Please Select
KG
01
02
03
04
05
06
07
08
09
10
11
12
Select from list
Last School Attended - Name
Name of School
Last School Attended - Location
City and State
Has this student, to your knowledge, ever been provided any of the support services listed Check all that apply.
Special Education (IEP)
504 Plan
English as a 2nd Language
Migrant Services
Physical Therapy Services
Speech 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.
Does this student applicant have a Brother or Sister currently enrolled in Silvies River Charter School
*
NO
YES
If Yes. What is the sibling's name
Student Lives with
Both Parents
Mother
Father
Grandparent(s)
Stepparent
Guardian / Foster Parent
Alone
Is student currently in Foster Care?
*
YES
NO
What is the primary eMail address to be used for contacting this applicant's parent(s)
*
PARENT MILITARY CONNECTION Is one or more parent or guardian a full-time member of the Army, Navy, Air Force, Marine Corps, Coast Guard or full-time National Guard Member. OR Is one or more parent or guardian on active duty for at least 180 days with a military reserve unit
*
YES
NO
Parent 1 Information
Parent 1 Relationship to Applicant Student
Please Select
Mother
Father
Stepfather
Stepmother
Grandparent
Guardian / Foster Parent
Parent 1 Name
First Name
Last Name
Which phone number(s) may we use to contact Parent 1
*
Home Phone
Cell Phone
Work Phone
None
Parent 1's Home Phone Number
FParent 1's Cell Phone Number
Parent 1's Work Phone Number
Is Parent 1's eMail address the same as the primary address provided above or different
*
Same
Different
Parent 1's eMail
Is Parent 1's Mailing Address the Same as the applicant student
YES
NO
Parent 1's Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Parent 2 Information
Would you like to add a 2nd parent / guardian's contact information
YES
NO
Parent 2's Relationship to Applicant Student
Please Select
Mother
Father
Stepfather
Stepmother
Grandparent
Guardian / Foster Parent
Parent 2's Name
First Name
Last Name
Which phone number(s) may be used to contact Parent 2
Home Phone
Cell Phone
Work Phone
None
Parent 2's Home Phone Number
Parent 2's Cell Phone Number
Parent 2's Work Phone Number
Is the Parent 2's eMail address the same as the primary address provided above or different
Same
Different
Parent 2's eMail
Is Parent 2's Mailing Address the same as the Applicant Student
YES
NO
Parent 2's Mailing Address.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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.
How did you learn about our program (Check any that apply)
Recommended by a friend
Recommended by a school counselor
From your web site
From an add in a local paper
From a printed flyer
From FaceBook
Enter Student's Date of Birth
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