The LINC High School Student Interest Form
This form will take you about 10-15 minutes to complete. It is not a guarantee of admission. After you submit this form, a staff member will review the information and contact you to discuss the options. Thank you for your interest in The LINC High School!
Last Name, First Name, Middle Initial of Student: *
Date of Birth of Student: *
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If the student currently attends a School District of Philadelphia public school, please provide his/her Student ID number:
Current Address, and Zip Code: *
Race Designation:
Country of birth:
Student Primary Language: *
Gender:
Student lives with: *
Name of Primary Parent/Guardian: *
Address: *
Telephone Number 1: *
Telephone Number 2:
Email Address (strongly recommended):
Name of Parent/Guardian:
Address:
Telephone Number 1:
Telephone Number 2:
Email Address:
Emergency Contact 1 Name, Relationship, Telephone Number (Will be contacted if unable to first communicate with parents/guardians): *
Emergency Contact 2 Name, Relationship, Telephone Number (Will be contacted if unable to first communicate with parents/guardians):
Please list any siblings/family members that have attended or are currently attending The LINC High School:
Indicate the city and name of school the student last attended:
Address of school:
Date last attended:
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If the student attended school outside of the United States, do you have his/her school records? If no, please contact that school and obtain those records for our review.
Has the student ever received Special Education Services in PA or another state? *
Does the student have a current IEP? *
Does the student have a current Evaluation Report? *
Has the student every received English as a Second Language (ESOL) or Bilingual Services? *
Does the student have a current 504 Plan in place? *
Language Survey: what language does the family speak at home most of the time?
What language does the parent speak to the child most of the time?
What language does the child speak to his/her parent most of the time?
What language does the child speak to his/her siblings most of the time?
What language does the child speak to his/her friends most of the time?
What language does the child speak most frequently?
What other languages does the child speak?
I certify that the information on this form is true and accurate information and that providing false or incomplete information may delay any meeting scheduled to occur with the school team. Please type your full name and date as signature of this statement. *
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