Welcome to Pacific Coast Satellite Academy!
Please complete this form to be considered for admission to PCSA. Completion of this form does not guarantee admission to our program; it is merely the first step in the process. Note: a separate form must be completed for each student you are requesting to enroll in Pacific Coast Satellite Academy.

If you have any questions or need assistance, please contact Rachel Kokosenski, M.Ed at rkokosenski@pacificcoastlc.com or (714) 485-9304. Thanks!
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Full Name of Parent #1 *
Does Parent #1 live with Student? *
Phone Number for Parent #1: *
Email address for Parent #1: *
Full Name of Parent #2: (write N/A if there is only one parent) *
Does Parent #2 live with Student? *
Phone Number for Parent #2 (write N/A, if applicable): *
Email address for Parent # 2 (write N/A, if applicable): *
Address of Student; please be sure to include city and zip code: *
Student's Full Legal Name: *
Sex of Student *
Date of Birth of Student: *
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Place of Student's Birth (City, State): *
Grade that Student will Enter the Program at: *
Name of Last School Attended: *
Address of Last School Attended: *
Pacific Coast Satellite Academy is a private school independent study program. As the teacher, the parent is responsible for implementing the student's course of study and returning documentation to PCSA.  
To initiate the registration process, please hit SUBMIT below. Once you are accepted into the program, you will be asked to submit tuition fees for each student and additional documentation. Thank you!
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