PIONEER CHARTER SCHOOL OF SCIENCE
Online Student Application Form
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  DEAR PARENTS AND APPLICANTS:
  Thank you for your interest in PIONEER CHARTER SCHOOL OF SCIENCE. This application form is expired and no longer in use. Please visit our website (www.pioneercss.org) to access the new application form. Pioneer Charter School of Science does not discriminate on the basis of race, color, national origin, creed, sex, gender identity, ethnicity, homelessness, sexual orientation, mental or physical disability, age, ancestry, athletic performance, special need, proficiency in the English language or a foreign language, or prior academic achievement.
   
   Applicant's Personal Information
   
      Year Applying: *
  Grade Applying: *
  School Applying:
  Last Name: *
  First Name: *
Middle Name:
  Suffix:
  Date of Birth: *
  Gender: *
 
   Applicant's School Information
   
  Current School: *
  School District: *
  School Address:
  School Phone:   XXX-XXXXXXX
  School Fax:   XXX-XXXXXXX
  Years Attended From:   *
 
   Applicant's Family Information
   
  Applicant lives with: * If Other  
         
  Primary Parent: * If Other: *
  Title:    
  First Name: * Last Name: *
  Street: *
  City: * State: *      Zip: *
  Home Phone: * Work Phone:
  Cell Phone: Email: *
         
  Secondary Parent: If Other :
  Title:    
  First Name: Last Name:
  Street:
  City: State:      Zip
  Home Phone: Work Phone:
  Cell Phone: Email:
         
 
Does the applicant student have a sibling(s) who is currently enrolled in this charter school? *
  If yes, list at least one sibling’s name, current grade and date of birth: *
         
   How did you hear about PIONEER CHARTER SCHOOL OF SCIENCE ?
   
   
       
           
  Please briefly state why you wish to have your child enrolled at PIONEER CHARTER SCHOOL OF SCIENCE.  
   
 
We hereby certify that, to the best of my/our knowledge and belief, the answers to the foregoing questions and statements made by me/us in this application are complete and accurate. I/We understand that any false information or misrepresentations of facts may result in rejection of this application or future dismissal of the applicant. We hereby certify that, to the best of my/our knowledge and belief, the answers to the foregoing questions and statements made by me/us in this application are complete and accurate. I/We understand that any false information or misrepresentations of facts may result in rejection of this application or future dismissal of the applicant.