YOUNG SCHOLARS OF CENTRAL PENNSYLVANIA
Student Database System © 2007-2008
ONLINE STUDENT APPLICATION FORM
 
     
  DEAR PARENTS AND APPLICANT:
  
    Thank you for your interest in Young Scholars of Central Pennsylvania. Please fill out this application form completely. Falsifications, misrepresentations or omissions may disqualify your application. Please note that a child must be 5 years old as of September 1, 2007 as the age requirement for 2007-2008 Kindergarten enrollment. Each class is planned to have maximum of 20 students  
   
  Applicant's Personal Information
   
  Year Applying:  
  Grade Applying: *  
  Last Name: *  
  First Name: *  
  Middle Name:  
  Suffix:  
  Date of Birth: *  
  Gender: *  
  Has applicant ever skipped a grade?
* , If Yes Which Grade :
  Has applicant ever repeated a grade?
* , If Yes Which Grade :
  Does the student have any learning disabilities?
*
  if yes, Explain:
 
If Yes, does the applicant currently have Individual Education Plan (IEP)?
*
  Please indicate any special health, or educational needs of which we should be aware of, and which will help us plan and provide for applicant's educational experience:
 
  Please list applicant's honors, awards, or special achievements (in or out of school):
 
  Please list applicant's talents, interests, hobbies, club memberships, and activities:
 
 
Is the applicant currently under expulsion from any school or school district?
*
  if yes, Explain: 
   
  Applicant's School Information  
   
  Current School: *  
  School District:  
  School Address:  
  School Phone:   XXX-XXXXXXX  
  School Fax:   XXX-XXXXXXX  
  Years Attended From:   to  *  
       
  Applicant's Family Information
   
  Applicant lives with: * If Other :
 

 

      
  Primary Parent/Guardian: * If Other : 
  Title :    
  First Name: * Last Name: *
  Address : *
  City: * State: *  Zip:  *
  Home Phone: * Work Phone:
  Cell Phone Email:
         
  Secondary Parent/Guardian: If Other :
  Title    
  First Name: Last Name:
  Address :
  City: State:     Zip: 
  Home Phone: Work Phone:
  Cell Phone Email:
         
  How did you hear about    Young Scholars of Central Pennsylvania?
   
   
     
           
  Please briefly state why you wish to have your child/children enrolled at    Young Scholars of Central Pennsylvania.  
   
 
I/We hereby certify that, to the best of my/our knowledge and belief, the answers to the foregoing questions and statements made by me/us in this application are complete and accurate. I/We understand that any false information, omissions, or misrepresentations of facts may result in rejection of this application or future dismissal of the applicant.