Paul Robeson High School Online Application
Name *
Last, First, Middle
Student ID
Date of Birth *
Best Telephone Number *
My child's CURRENT grade level *
Sex *
Home Address *
House/Apt# Street Zip
Second Address
House/Apt# Street Zip
Parent/Guardian #1 Name *
Last, First
Parent/Guardian #1 Phone *
Parent/Guardian #1 Email *
Parent/Guardian Alternate Phone number *
Work, house phone, etc.
Parent/Guardian #2 Name (if applicable)
Last, First
Parent/Guardian #2 Phone (if applicable)
Parent/Guardian #2 Email (if applicable)
Parent/Guardian #2 Alternate Phone Number (if applicable)
Work, house phone, etc.
PSSA/Keystone Math *
PSSA/Keystone English Language Arts *
PSSA/Keystone Science/Biology *
Is Emergency Contact already listed? *
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