Pocosin Innovative Charter
2021-2022 Pre-Lottery Enrollment Application
Email address *
Student's First Name *
Student's Middle Name
Student's Last Name *
Student's Date of Birth *
Grade entering the 2021-2022 School year *
Current Grade Level *
School Currently Attending?
Is your applicant a twin or triplet? **Please submit one application for each student. ** *
Preferred Enrollment: Is the applicant currently attending a NC Charter School?
Clear selection
Preferred Enrollment: Is the applicant a sibling of a currently enrolled PIC student? *
Preferred Enrollment: Is the applicant a child of a full-time employee or board member? *
Preferred Enrollment: If you receive any state aid for Medicare/Medicaid/Food Stamps or if your child currently receives free/reduced lunch in school, please click yes below. (All information is confidential) *
Street Address *
City *
Zip *
Primary Phone # *
Alternate Phone #
Primary E-mail Address *
Enter N/A if you do not have one.
Full Name of Mother/Guardian *
Mother/Guardian Phone # (if different than student)
Mother/Guardian Email
Full Name of Father/Guardian *
Father/Guardian Email
Father/Guardian Phone # (if different than student)
If any information on this application is falsified, the applicant's name will be taken out of the lottery, removed from the wait list, or removed from enrollment at the time the information is found to be inaccurate. This includes, but not limited to, information pertaining to a student's current grade level or Date of Birth. *
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