Pioneer Preparatory - Registration Form

Previous School Information

The following questions are not required questions, and you may choose to leave them unanswered.
Name of the previous School
Last day attended

MonthDayYear
Date
Previous School Attended Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Grade Attended

Parent/Guardian Information

(Must be listed on birth certificate or legal custody document)
Parent / Guardian Full Name*

First NameMiddle NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone*
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Email *
example@example.com
Check all that apply*

Student lives withEducation RightsContact AllowedHas Custody
Want to add a second parent?
Parent / Guardian #2 Full Name

First NameMiddle NameLast Name
Home Address #2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone #2
Please enter a valid phone number.
Cell Phone #2
Please enter a valid phone number.
Work Phone #2
Please enter a valid phone number.
Email #2
example@example.com
Check all that apply #2

Student lives withEducation RightsContact AllowedHas Custody

Home Language Survey

The responses to this Home Language Survery (HLS) are used by the school to provide the most appropriate instructional programs and services for the student. The answers below will determine if a studen will take the Arizona English Language LearnerAssessment (AZELLA). Please respond to each of the three questions as accurately as possible..
What language do people speak in the home most of the time?*
What language does the student speak most of the time?*
What language did the student first speak or understand?*
District Student ID
SSID

Pioneer Preparatory School