Application

62 Holly Avenue, Denmark, SC 29042
Phone: 803-541-6021
Student Information
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
Date
DOB (Month and Year)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Last School Attended
Name of School
School Year
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Did you (the student) receive any Special Education Services as indicated through an IEP?
Signature
Date

MonthDayYear
Date
Please verify that you are human
After you submit this form, you will be redirected to the registration form that must be completed.
Should be Empty:

Student Information