Application for the 2021-2022 school year
All applications must be submitted no later than March 5th at 5:00 pm. If you have any questions about the application process please reach out to:
Keith Barnett at (336) 634-3209 or Dr. Charles Perkins at (336)-627-2621
Student Last Name *
Student First Name *
Address (Example: 1201 Harris St, Eden NC 27288) *
Parent/Guardian's Name *
Parent/Guardian's Phone Number *
Parent/Guardian's Email Address *
Clear selection
Student Ethnicity (Check all that apply) *
Do you have access to reliable internet? *
Current Grade level *
Are you currently enrolled in Rockingham County Schools? *
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