ECPHS Enrollment Forms '23 - '24
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Email *
Student's Last Name *
Student's First Name *
Student's Date of Birth *
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/
DD
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Place of Birth (city & state)
Student's Social Security Number
Student's grade for the '22-'23 school year *
Last School Student Attended (School Name, City, State) *
Primary Parent or Guardian's Name & Phone Number: *
Primary Parent or Guardian Relationship to child: *
Required
Primary Parent Email Address
2nd Parent or Guardian's Name & Phone Number:
2nd Parent Email Address
2nd Parent or Guardian's Relationship to child:
Student's physical address: *
Student's Mailing Address (if different):
City: *
Zip Code: *
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 ?
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1st Emergency Contact (name, relationship to student, phone number): *
2nd Emergency Contact (name, relationship to student, phone number): *
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.)
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Does your student have an IEP (Individualized Education Plan)?
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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)
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