Enrollment Application
SAFETY, RESPECT, LEARNING & COMMUNITY
196 Cesar E. Chavez Ave. Pontiac, Michigan 48343
P: 248-745-9420
E: enrollment@pontiacacademy.org
If you are re-enrolling, please use the following link, https://forms.gle/x6JsNL3kjNp7Ywe49

When enrolling for Kindergarten, please submit the following information to Principal Williams, williamsp@pontiacacademy.org

A copy of the applicant’s birth certificate (need to see original).
A complete health report (Kindergarten applicants only) completed by a medical personnel. Including vision (MUST HAVE) and hearing screening.
An updated immunization record (Must have the most recent immunization).

Pontiac Academy for Excellence will be 100% Virtual this Fall 2020.
Email address *
Building Level *
Today’s Date *
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Has your child ever attended any school before? *
Student Name (Last, First, Middle Initial) *
Other Last Name Student may use
Entering Grade *
Gender *
Was the student born outside of the US? *
If born outside the US, when did the student enter US schools?
Is your child’s native tongue a language other than English?
Clear selection
If yes, what is that language?
Is the primary language used in your child’s home or environment a language other other than English?
Clear selection
If yes, What is the language?
Is your child Hispanic/Latino? (Choose one)
Clear selection
Ethnicity *
Required
Education Services:
Birth date *
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Birth Place *
Phone Number *
Address *
Adult Parent/Guardian Name *
Home/Cell Phone Number *
Work Phone Number
E-mail address
Adult Parent/Guardian Name
Home/Cell Phone Number
Work Phone Number
E-mail address
How did you hear about our school?
Emergency Medical Conditions/Problems: check ALL that apply
Will your child be taking medication during school hours?
Clear selection
Other children who reside in the home (Name, Birth date, Grade, Attending P.A.E.)
Does your child attend a daycare center or go to a sitter after school?
Clear selection
Do you affirm, that as the parent/legal guardian, all information provided above is true and accurate, and that my child and I reside at the listed address. *
A copy of your responses will be emailed to the address you provided.
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