Admissions to Pineywoods Community Academy~ Learn more about our admission policies, dress code, and even apply to attend online.

Online Application

Pineywoods Academy Charter School

(as listed on birth certificate)



Male  Female 





Yes  No 




(if different from above)











-


Public School 
Private School - Non-Religious Affiliated 
Private School - Religious Affliated 
Charter School 
Home School 
School outside of the Country 







-


Public School 
Private School - Non-Religious Affiliated 
Private School - Religious Affliated 
Charter School 
Home School 
School outside of the Country 


Mother  Guardian 
Father  Guardian 



















Mother  Father  Both  Guardian  Other 

Yes  No 


Yes  No 

Yes  No 

Yes  No 

African American  Hispanic  Native American  White (not of hispanic origin)  Asian - Pacific Islander 


Yes  No 

Yes  No 

Yes  No 

Yes  No 


Yes  No  Not Sure 
If “yes”, please provide a copy of the latest IEP, a copy of latest Full and Individual Evaluation (FIE) and copy of the latest ARD (Admission, Referral, and Dismissal).

Yes  No  Not Sure 

Yes  No  Not Sure 

Yes  No  Not Sure 


Yes  No  Not Sure 

(MM/DD/YYYY)

Yes  No 

I confirm that I have requested enrollment for (student’s name) at Pineywoods Academy Charter School for the 2009-2010 school year, and that in order to maintain active enrollment I must abide by the terms set forth in the Pledge to Excellence document. In addition to this completed a signed Pineywoods Academy enrollment form, other documents required to complete the enrollment process include:

  • A legible copy of social security card.
  • A legible copy of the parent’s driver’s license.
  • A legible copy of the immunization record.
  • A legible copy of the birth certificate for students in grades 1 through nine must be received within 6 months from the 1st day of enrollment. Pre Kindergarten and Kindergarten students must provide their birth certificate so the enrollment process can be completed.

The Undersigned parent / legal guardian has read, understands, and agrees to the following:

  1. The enrollment of this student in Pineywoods Academy constitutes this student’s complete educational program.
  2. A signature on this enrollment form shall be deemed consent for Pineywoods, as part of the admission process to acquire the cumulative files from the student’s prior school. However, as part of this standard admission process, parents / legal guardians will be asked to sign an Authorization for Release of Records Form. This form must be completed before enrollment is complete.
  3. Completion of this enrollment process does not guarantee student enrollment in Pineywoods Academy. When all required items are received and the application is complete, you will be contacted when space becomes available. (In complete packets will not be processed or considered for enrollment.)

I hereby certify the information provided on this form, the Pledge to Excellence form, and other documentation for enrollment are true, correct, and current. In addition, any false information provided can result in removal from Pineywoods Academy.

Mother / legal guardian signature:
Date: Saturday, May 19, 2012

Please print name:

Father / legal guardian signature:
Date: Saturday, May 19, 2012

Please print name:

Please deliver or mail completed enrollment packets to:

Pineywoods Academy Charter School
602 South Raguet
Lufkin, Texas 75904
Phone: (936) 634-5515
Fax: (936) 634-5518

Please note: Submission of this enrollment form does not guarantee enrollment.