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.
Email address *
Student's Name *
Student's Birthday *
Grade Level for 2021-22 *
Is this applicant a sibling to an existing student? *
If yes, what are the existing student's names?
Student's Physical Address *
Student's Mailing Address (if different from physical)
Student's Resident School District *
Current School Attending
Parent/Legal Guardian's Name(s) *
Parent/Legal Guardian's Phone Number *
A copy of your responses will be emailed to the address you provided.
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