Name of Parent(s) *
Your answer
Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Contact Phone Number *
Your answer
Email *
Your answer
Name of Child *
Your answer
Birthdate of Child *
MM
/
DD
/
YYYY
Child’s Columbia Public School Attendance Area *
This is a required question
Your answer
Are you a Columbia Public School employee? *
If you are a CPS employee, what building do you work in?
Your answer
Does your child qualify for ECSE or Title I ? *
List any Food Allergies of the Child
Your answer
Requested Begin Date of Enrollment *
MM
/
DD
/
YYYY
Request for Scholarship Information *
Families must qualify for free/reduced lunch to be eligible for scholarship
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