PHILADELPHIA CHARTER SCHOOL COMMON APPLICATION
SECTION A: STUDENT & PARENT/GUARDIAN INFORMATION
Name
*
First Name
Last Name
Current Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender (optional)
Parent /Guardian
*
First Name
Last Name
Relationship
*
Do you have the legal right to enroll this child in school?
*
Yes
No
Preferred Contact Number:
*
-
Area Code
Phone Number
Secondary Contact Number:
-
Area Code
Phone Number
Email
*
example@example.com
Current Grade Level :
*
SECTION B: SCHOOL CHOICE INFORMATION
Name of Charter School You Wish To Attend:
*
Grade Applying To:
*
SECTION C: SIBLING INFORMATION
SIBLING #1
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
School Sibling Currently Attends:
SIBLING #2
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
School Sibling Currently Attends:
SIBLING #3
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
School Sibling Currently Attends:
SECTION D: PARENT/GUARDIAN SIGNATURE
IMPORTANT: By signing this form, you indicate that all information provided is accurate. If any of the information that you have provided changes after turning in this form, please submit an amended form prior to the school’s deadline. Check with the charter school you wish to apply to for application deadlines. YOU MUST SUBMIT THIS FORM TO THE CHARTER SCHOOL YOU WISH TO ATTEND.
Parent/Guardian Signature:
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: