Pollock Moore Academy Student Enrollment Interest Form
CONFIDENTIAL This form does not admit students into the school, but allows the school to track students interested in applying for enrollment. Students must be in grades 9-12 for the 2021-2022 school year and be a resident of the state of Georgia who can provide his or her own transportation to and from school. By submitting this form, parents and students are giving representatives of Pollock Moore Academy, Inc. to contact them regarding possible admission into the public charter high school. Potential students and parents may read about the school model at
THE INFORMATION SUBMITTED THROUGH THIS FORM IS CONFIDENTIAL. Specific data will only be reviewed by members of the school's founding board. The State Charter School Commission and other stakeholders will receive summaries of the data.
What is the student's full name? (Be sure to complete a form for each individual student.)
What grade will the student be in for the 2020-2021 school year?
8th grade (We will not offer 8th grade in 2020-2021, but we would like to know interest for the following school year.)
What are the names of the student's legal guardian(s) or parents(?)
What is the student's mailing address?
What is the student's home email address? Students may use parent/guardian email addresses.
What is the student's home telephone number, and who may we speak with when we call?
What job(s) or career(s) is the student planning on pursuing in his or her future? Name up to three.
Check the following career pathways that you or your student may be interested in taking at PMA.
Manufacturing and Mechatronics (Robotics Manufacturing and Automation) or Industrial Maintenance
Innovative Teaching and Teaching as a Profession
Cyber Security and Coding
Is the student interested in participating in any of the following athletic programs?
Track and Field
Is your student interested in participating in any of the following extracurricular programs?
Drama Club, One Act Play, or Literary
Volunteer / Service Clubs
Yearbook or Newspaper Club
Future Business Leaders of America
Debate or Mock Trial Team
Skills USA Team for welding, constructing, industrial maintenance, art, etc.
Dance Team or Step Team
Would the student be available to attend PMA in 2020-2021?
Would the student be available to attend PMA in 2021-2022?
How did the student or parent hear about PMA? Please check all that apply to help us with reaching more students.
Word of Mouth
Do you have any questions or comments for PMA? (Optional Questions)
A copy of your responses will be emailed to the address you provided.
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