Paul Robeson High School Online Application

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Name *

Last, First, Middle

Student ID

Date of Birth *

Best Telephone Number *

My child's CURRENT grade level *

9th Grade

10th Grade

11th Grade

12th Grade

Other:

Sex *

Female

Male

Non-binary/Gender non-conforming

I'd prefer not to say this time

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 *

Proficient/Advanced

Basic

Below Basic

Don't know/Did not take test

PSSA/Keystone English Language Arts *

Proficient/Advanced

Basic

Below Basic

Don't know/Did not take test

PSSA/Keystone Science/Biology *

Proficient/Advanced

Basic

Below Basic

Don't know/Did not take test

Is Emergency Contact already listed? *

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