Princeton Online MN (POM)                                    Full-Time Enrollment Form
Please complete this form for your Princeton Online MN student. This form is an annual, once per year, Minnesota State Requirement making sure that POM did not force you to take an online course or register in our program!  Thank you for completing the following form! :)
Email *
Student Last Name *
Student First Name *
Student's Phone or Cell Number *
Please provide best number for coordinator or instructor to contact student regarding courses, questions, tech help, etc.
Is your student a new or returning student? *
Student's Current Grade/Grad Year *
Date your student enrolled in Princeton Online MN *
Parent/Guardian #1 Name *
Enter Last Name, First Name
Parent/Guardian #1 Phone *
Parent/Guardian #1 Email Address *
Parent/Guardian #2 Name
Enter Last Name, First Name
Parent/Guardian #2 Phone
Parent/Guardian #2 Email Address
Last School Student Attended *
Reason for Enrolling in Online Courses *
Physical Health (list any physical health-related concerns for the student's file)
Mental Health (list any mental health-related concerns for the student's file)
Emergency Medical Authorization:  As the parent/guardian of the above-named student, in case I am unable to be reached during any emergency, I hereby authorize a representative of the school to act as an agent to consent to the giving of any and all medical, dental, hospital, or surgical care to the above-named student. *
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