2025-2026 Providence Learning Center Enrollment Interest Form

Providence Learning Center Enrollment Interest Form 2025-2026
Documents needed for Enrollment Interest Meeting

Please bring the following documentation to the enrollment interest meeting after this form is submitted and Providence Learning Center Staff has scheduled your meeting.

• Original Certified Birth Certificate
• Original Social Security Card
• Current Immunization Form
• Current Proofs of Residence (ex. power, water or gas bill)
Student Information
Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Ethnicity
Grade
Enrollment Semester
Current Residence Information
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Contact Information
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Parent/Guardian Contact Information (2)
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Previous School
School Name
City
State
Date Started

MonthDayYear
Date Ended

MonthDayYear
My child participated in a homeschool option

YesNo
Does your child receive Special Education Services?

YesNo
Thank you for submitting this Enrollment Interest Form! Providence Learning Center will contact you to set up a pre-enrollment meeting with our directors.
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Providence Learning Center Enrollment Interest Form 2025-2026