PPEP TEC High School Enrollment Continuation Form

PPEP TEC HIGH SCHOOL-Alice Paul Learning Center

Casa Grande, Arizona
STUDENT CONTINUATION FORM
SY 2023-24
STUDENT INFORMATION
LAST*
FIRST*
DATE OF BIRTH*

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number/WhatsApp
Please enter a valid phone number.
Email Address
example@example.com
PARENT/GUARDIAN INFORMATION
With whom does the student currently live?
Please Select One*

MotherFatherSelfOther
NAME
Relationship
Street Address
State
Zip Code
Cell Phone/WhatsApp
Email Address
EMERGENCY CONTACT INFORMATION
NAME
RELATIONSHIP
Phone Number/WhatsApp
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Email Address
We/l the undersigned hereby certify that to the best of our/my knowledge and belief, the answers to the foregoing questions and statements made by us/me in this application are complete and accurate. We/I understand that any false information amissions or misrepresentation of facts may result in rejection of this application or future dismissal of the applicant. Student the 18 and/or Parent/Legal Guardian of this student. By signing this form, attest to be residents of the State of Arirona having already provided the school with a copy an acceptable document that displays the name and residential address or description of the proserty where this student resides;
PARENT/GUARDIAN SIGNATURE

Clear
DATE

MonthDayYear
Date
STUDENT SIGNATURE*

Clear
DATE*

MonthDayYear
Date
Exceptional Education & McKinney Vento Act Eligibility

This information is utilitzed by the Arizona and U.S. Department of Education to determine if PPEP TEC High School is eligible for additional funding for student services.
Is the student currently receiving Exceptional Educational Services, (SPED)*

YESNO
Please note: PPEP TEC is committed to providing the best educational apportunity to every student. We ask for the above information in order to ensure continuity of services, in keeping with that commitment.
Is your current address a temporary living arrangement?*

YesNo
Is your temporary living arrangement due to housing or economic hardship?

YesNo
If you answered NO to the questions above stop here.

THANK YOU.
Type a question

Is the student (family) livind in a shelter?Is the student (family) living with another family/group of people?Is the student (family) living in a motel/hotel?Is the student (family) living in a spacke not suitable for living or inadequate: car, park, building not made for living, in a home without heating/cooling, running water, restroom, etc.Is the student seeking enrollment WITHOUT a parent or legal guardian?
WHAT OTHER Services ARE NEEDED/DESIRED
Should be Empty:

PPEP TEC HIGH SCHOOL-Alice Paul Learning Center

STUDENT CONTINUATION FORM

SY 2023-24

STUDENT INFORMATION

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACT INFORMATION