2023-2024 New Student Enrollment Application
Thank you for your interest Breakthrough Charter School for your child! We are committed to offering a unique, diverse education option for families in Perry County and surrounding counties.

Returning students will complete a different form. This form is intended for new students interested in enrollment.

Please complete one application per child. Priority enrollment ends Sunday, March 19, 2023 at 11:59 PM. In the event of a lottery, families will be contacted about the time and location.

Questions? Contact us at breakthroughcharterschool@gmail.com.
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Email *
Enrollment Information
Primary Email Address (REQUIRED) *
This email address will be used for all enrollment communication.
Primary Phone Number (REQUIRED) *
This phone number will be used for all enrollment communication.
Student Information
Student's Legal LAST Name: *
Student's Legal FIRST Name: *
Student's Legal MIDDLE Name: *
Student's Preferred Name: *
Student's Date of Birth *
MM
/
DD
/
YYYY
Student's Grade Level for 2023-24 Academic Year: *
School Student Currently Attends: *
Home Phone Number: *
Home Address: *
City: *
State: *
Zip Code: *
Does the student have a sibling/siblings that already attend Breakthrough Charter School? If so, please list them here.
Does the student have a sibling/siblings planning to enroll at Breakthrough Charter School? If yes, please type their full names below. Be sure to complete an application for any other siblings attending.
Is the student the child of a Breakthrough Charter School board member, faculty, or staff member? *
Student Lives With: *
Special Information about Custody:
Father/Guardian Information
Father/Guardian's Full Name:
Home Address (if different from student's address):
City:
State:
Zip Code:
Father/Guardian's Email Address:
Father/Guardian's Phone Number:
Mother/Guardian Information
Mother/Guardian's Full Name:
Home Address (if different from student's address):
City:
State:
Zip Code:
Mother/Guardian's Email Address:
Mother/Guardian's Phone Number:
Parent/Guardian Signature
By typing your name below, you are affirming that, to the best of your knowledge, the information and decision to apply your child for enrollment in the 2022-2023 school year is accurate. *
If you were referred by someone, please type the name of the person below.
A copy of your responses will be emailed to the address you provided.
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