ECPHS Enrollment Forms '21 - '22
Email *
Clear selection
Student's Last Name *
Student's First Name *
Student's Date of Birth *
Place of Birth (city & state)
Student's Social Security Number
Student's grade for the '21-'22 school year *
Last School Student Attended (School Name, City, State) *
Primary Parent or Guardian's Name & Phone Number: *
Primary Parent or Guardian Relationship to child: *
Primary Parent Email Address
2nd Parent or Guardian's Name & Phone Number:
2nd Parent Email Address
2nd Parent or Guardian's Relationship to child:
Student's physical address: *
Student's Mailing Address (if different):
City: *
Zip Code: *
Transfer Information: Do you and your child live in the Elmore City-Pernell School District?
Clear selection
Do you plan to move within the school year ?
Clear selection
1st Emergency Contact (name, relationship to student, phone number): *
2nd Emergency Contact (name, relationship to student, phone number): *
Select one or more of the following races. *
Does your student have a tribal citizenship card? (If yes, please present this card to the school office.)
Clear selection
Does your student have an IEP (Individualized Education Plan)?
Clear selection
Please rank your choices for electives in order of preference from 1-4 with 1 being the most desired elective. Understand, you may not get your top choices but we will try our best to accommodate you. Only pick ONE for each Column.
1st Choice
2nd Choice
3rd Choice
4th Choice
American Sign Lang. I
American Sign Lang. II (prerequisite)
Spanish I
Spanish II (Prerequisite)
Technology Education
HS Band
Boy's HS Atheletics
Girl's HS Atheletics
Computer I
Computer II (Prerequisite)
Yearbook (submit application to Mrs. Henry)
Teacher or Office Aid (see Mrs. Henry)
HS Agriculture
Ag Mechanics (Prerequisite)
Vocal Music
Internship (Seniors Only, 2-3 hours, must be accepted to program)
Senior Service Project (Seniors, must be approved by Mrs. Doss only)
Mid-America Tech Center (Juniors/Seniors only)
Concurrent College Classes(see Mrs. Henry, must have 19 on ACT)
History of Aviation (9th graders entering Aviation Program)
Never submit passwords through Google Forms.
This form was created inside of Elmore City-Pernell Schools. Report Abuse