New Student Application
Applying will only take a few minutes. A student's application is non-committal and does not guarantee enrollment. We are looking forward to to receiving your application soon!
Student Information
Student 1
Name
*
First Name
Middle Name
Last Name
Gender
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Grade Entering
*
Please Select
K4 (Pre K)
K5 (Kindergarten)
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Has this student attended PCS in the past?
*
Please Select
Yes
No
Students overall grades have been:
*
Please Select
Superior (90-100)
Above Average (80-89)
Average (70-79)
Below Average (69 and below)
Has the student failed (or been held back in) any grade level?
*
Please Select
Yes
No
If yes, which grade level?
Please Select
K4 (Pre K)
K5 (Kindergarten)
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Has Student been absent been absent more than 10 days during the most recent school term?
*
Please Select
Yes
No
If yes, please explain:
Has this Student experienced academic, social, or disciplinary challenges during his/her school career?
*
Please Select
Yes
No
If yes, please explain:
Has he/she been expelled or given an in-school or out-of-school suspension during his/her school career?
*
Please Select
Yes
No
If yes, please explain:
Has he/she been recommended for testing or diagnosed as having a learning disability or any condition that would affect educational performance?
*
Please Select
Yes
No
If yes, please explain:
Has Student experienced a traumatic event affecting his/her behavior?
*
Please Select
Yes
No
If yes, please explain:
Is Student currently taking any prescription medications to aid behavior or academic performance?
*
Please Select
Yes
No
If yes, please explain:
Do you have another Student
*
Yes
No
Back
Next
Student 2
Name
First Name
Middle Name
Last Name
Gender
Male
Female
Date of Birth
-
Month
-
Day
Year
Date
Grade Entering
Please Select
K4 (Pre K)
K5 (Kindergarten)
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Has this student attended PCS in the past?
Please Select
Yes
No
Students overall grades have been:
Please Select
Superior (90-100)
Above Average (80-89)
Average (70-79)
Below Average (69 and below)
Has the student failed (or been held back in) any grade level?
Please Select
Yes
No
If yes, which grade level?
Please Select
K4 (Pre K)
K5 (Kindergarten)
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Has Student been absent been absent more than 10 days during the most recent school term?
Please Select
Yes
No
If yes, please explain:
Has this Student experienced academic, social, or disciplinary challenges during his/her school career?
Please Select
Yes
No
If yes, please explain:
Has he/she been expelled or given an in-school or out-of-school suspension during his/her school career?
Please Select
If yes, please explain:
Has he/she been recommended for testing or diagnosed as having a learning disability or any condition that would affect educational performance?
Please Select
Yes
No
If yes, please explain:
Has Student experienced a traumatic event affecting his/her behavior?
Please Select
Yes
No
If yes, please explain:
Is Student currently taking any prescription medications to aid behavior or academic performance?
Please Select
If yes, please explain:
Do you have another Student
Yes
No
Back
Next
Student 3
Name
First Name
Middle Name
Last Name
Gender
Male
Female
Date of Birth
-
Month
-
Day
Year
Date
Grade Entering
Please Select
K4 (Pre K)
K5 (Kindergarten)
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Has this student attended PCS in the past?
Please Select
Yes
No
Students overall grades have been:
Please Select
Superior (90-100)
Above Average (80-89)
Average (70-79)
Below Average (69 and below)
Has the student failed (or been held back in) any grade level?
Please Select
Yes
No
If yes, which grade level?
Please Select
K4 (Pre K)
K5 (Kindergarten)
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Has Student been absent been absent more than 10 days during the most recent school term?
Please Select
Yes
No
If yes, please explain:
Has this Student experienced academic, social, or disciplinary challenges during his/her school career?
Please Select
Yes
No
If yes, please explain:
Has he/she been expelled or given an in-school or out-of-school suspension during his/her school career?
Please Select
If yes, please explain:
Has he/she been recommended for testing or diagnosed as having a learning disability or any condition that would affect educational performance?
Please Select
Yes
No
If yes, please explain:
Has Student experienced a traumatic event affecting his/her behavior?
Please Select
Yes
No
If yes, please explain:
Is Student currently taking any prescription medications to aid behavior or academic performance?
Please Select
If yes, please explain:
Back
Next
Family Information
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parental marital status
*
Please Select
Married
Separated
Divorced
Unmarried
Who has legal custody of the Student?
*
Please Select
Father and Mother
Mother
Father
Other
Mother/Guardian Name
*
First Name
Last Name
Living with Family?
*
Please Select
Yes
No
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Father/Guardian Name
*
First Name
Last Name
Living with Family?
*
Please Select
Yes
No
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Back
Next
General Information
Do you presently have other Students enrolled at PCS?
*
Please Select
Yes
No
Optimal Start Date
*
ASAP
Next Semester
Next School Year
Other
Last School Attended
*
Previous School Information
*
Address and Phone
Reason or leaving previous school
*
How did you find out about PCS?
*
Please Select
Friend
Advertisement
Search Engine
Other
Why do you want this Student to attend PCS?
*
Family's Church
*
Pastor's Name
*
First Name
Last Name
Is the Student's mother/guardian a Christian?
*
Give a brief testimony
Is the Student's father/guardian a Christian?
*
Give a brief testimony
To the best of my knowledge, the information given on this questionnaire is true and accurate.
*
I agree
Parent/Guardian, please sign your full name:
*
Continue
Continue
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