Application to Enroll 2021-22
Thank you for considering PBCCS as the school for your child(ren).
Please note: This form MUST be submitted NO LATER THAN MARCH 15TH for your child to be entered for the 2021-22 school year lottery.
Incoming kindergarteners must be 5 on or before September 1, 2021.
Powell Butte Community Charter School does not limit student enrollment based on race, religion, sex, sexual orientation, ethnicity, national origin, disability, terms of an individual education program, income level, proficiency in the English language or athletic ability.
* Required
Email address
*
Your email
Student's Name
*
Your answer
Student's Birthday
*
Your answer
Grade Level for 2021-22
*
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh grade
Eighth Grade
Required
Is this applicant a sibling to an existing student?
*
Yes
No
Required
If yes, what are the existing student's names?
Your answer
Student's Physical Address
*
Your answer
Student's Mailing Address (if different from physical)
Your answer
Student's Resident School District
*
Your answer
Current School Attending
Your answer
Parent/Legal Guardian's Name(s)
*
Your answer
Parent/Legal Guardian's Phone Number
*
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Powell Butte Community Charter School.
Report Abuse
Forms
