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
* Required
Student Last Name
*
Your answer
Student First Name
*
Your answer
Address (Example: 1201 Harris St, Eden NC 27288)
*
Your answer
Parent/Guardian's Name
*
Your answer
Parent/Guardian's Phone Number
*
Your answer
Parent/Guardian's Email Address
*
Your answer
Gender
Female
Male
Clear selection
Student Ethnicity (Check all that apply)
*
American Indian/Alaskan Native
Asian
Black or African American
Hispanic
Multi (Two or more)
Native Hawaiian/Pacific Islander
White
Other:
Required
Do you have access to reliable internet?
*
Yes
No
Other:
Current Grade level
*
3rd
4th
5th
6th
7th
Are you currently enrolled in Rockingham County Schools?
*
Yes
No
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