Pine Haven Enrollment Form: General Student Information
Hello! This form will provide PHE with the primary information we need for your student. There are documents that will need to be submitted as part of the enrollment process, but a date will be organized in the future on which parents/guardians can come to the school and submit those documents. We are excited to have your student be a Miner!
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First Name *
Middle Name *
Last Name *
Birthdate *
MM
/
DD
/
YYYY
Gender *
Grade *
Nickname
Social Security Number *
If you wish to withhold your student's SSN, you may enter N\A to request that the school district assign your child a nine-digit number designated by the Department of Education.
Hispanic/Latino Ethnicity *
Race *
Additional Races (check all that apply) *
Required
Language Spoken at Home *
Student Email Address
Student Home Phone *
Student Cell Phone
Does your student have access to high-speed internet? *
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