Last School Student Attended (School Name, City, State) *
Your answer
Primary Parent or Guardian's Name & Phone Number: *
Your answer
Primary Parent or Guardian Relationship to child: *
Required
Primary Parent Email Address
Your answer
2nd Parent or Guardian's Name & Phone Number:
Your answer
2nd Parent Email Address
Your answer
2nd Parent or Guardian's Relationship to child:
Student's physical address: *
Your answer
Student's Mailing Address (if different):
Your answer
City: *
Your answer
Zip Code: *
Your answer
Transfer Information: Do you and your child live in the Elmore City-Pernell School District?
Clear selection
Do you plan to move within the school year ?
Clear selection
1st Emergency Contact (name, relationship to student, phone number): *
Your answer
2nd Emergency Contact (name, relationship to student, phone number): *
Your answer
Select one or more of the following races. *
Required
Does your student have a tribal citizenship card? (If yes, please present this card to the school office.)
Clear selection
Does your student have an IEP (Individualized Education Plan)?
Clear selection
Please rank your choices for electives in order of preference from 1-4 with 1 being the most desired elective. Understand, you may not get your top choices but we will try our best to accommodate you. Only pick ONE for each Column. (Prerequisite means a prior course in that field, etc...Ag I before any other Ag class. 8th grade Ag does not count as Ag I.)
1st Choice
2nd Choice
3rd Choice
4th Choice
Art I
HS Band
Boy's HS Atheletics
Girl's HS Atheletics
Computer I or Google Tools
Computer II (Prerequisite) or Google Tools
History of Religion
Yearbook (submit application to Mrs. Henry)
Teacher or Office Aid (see Mrs. Henry)
HS Agriculture
Ag Mechanics (Prerequisite)
Vocal Music
Internship (Seniors Only, 2-3 hours, must be accepted to program)
Mid-America Tech Center (Juniors/Seniors only)
Concurrent College Classes(see Mrs. Henry, must have 19 on ACT)
STEM
History of Aviation (9th graders entering Aviation Program)
Aviation 2 (prerequisite)
eSports Elective
Junior Internship(Juniors ONLY 1-2 hours)
1st Choice
2nd Choice
3rd Choice
4th Choice
Art I
HS Band
Boy's HS Atheletics
Girl's HS Atheletics
Computer I or Google Tools
Computer II (Prerequisite) or Google Tools
History of Religion
Yearbook (submit application to Mrs. Henry)
Teacher or Office Aid (see Mrs. Henry)
HS Agriculture
Ag Mechanics (Prerequisite)
Vocal Music
Internship (Seniors Only, 2-3 hours, must be accepted to program)
Mid-America Tech Center (Juniors/Seniors only)
Concurrent College Classes(see Mrs. Henry, must have 19 on ACT)
STEM
History of Aviation (9th graders entering Aviation Program)
Aviation 2 (prerequisite)
eSports Elective
Junior Internship(Juniors ONLY 1-2 hours)
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Elmore City-Pernell Schools. Report Abuse