Pocosin Innovative Charter
2020-2021 Pre-Lottery Enrollment Application
Email address *
Student's First Name *
Your answer
Student's Middle Name
Your answer
Student's Last Name *
Your answer
Student's Date of Birth *
MM
/
DD
/
YYYY
Grade entering the 2020-2021 School year *
Current Grade Level *
School Currently Attending?
Your answer
Is your applicant a twin or triplet? **Please submit one application for each student. ** *
Required
Preferred Enrollment: Is the applicant currently attending a NC Charter School?
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 *
Your answer
City *
Your answer
Zip *
Your answer
Primary Phone # *
Your answer
Alternate Phone #
Your answer
Primary E-mail Address *
Enter N/A if you do not have one.
Your answer
Full Name of Mother/Guardian *
Your answer
Mother/Guardian Phone # (if different than student)
Your answer
Mother/Guardian Email
Your answer
Full Name of Father/Guardian *
Your answer
Father/Guardian Email
Your answer
Father/Guardian Phone # (if different than student)
Your answer
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. *
Required
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