.: Pineywoods Community Academy - Application for Admission :.

Application for Admission

Fill out the form below to express interest in
applying for the current school year.

*NOTE: This does not guarantee your student a spot. You must still pickup and complete a packet of information from our office.

	STUDENT INFORMATION
	Grade for 2007/2008 School Year:
	Last Name:		First Name:
	Middle Name:		Generation:
	Birth Date:		Age on Sept. 1st:

	Student Address:		Phone #:
	City/State/ZIP:
	PARENT/GUARDIAN INFORMATION
	1st - Parent/Guardian:		Relationship:
	Address:		City/State/ZIP:
	Home Phone:		Place of Employment:
			Work Phone:

	2nd - Parent/Guardian:		Relationship:
	Address:		City/State/ZIP:
	Home Phone:		Place of Employment:
			Work Phone:
	OTHER INFORMATION
	Previous School(s) Attended:
			Begin with the last school attended.
	Students with a documented history of a criminal offense, juvenile court adjudication, or discipline problems under TEC Subchapter A, Chapter 37 may be excluded. See TEC 12.111(6).
	Does your student fall into any of the above categories?
	If so, please explain:
	Any Additional Info:
	Enter Verification Code (This must be done for security):

	In accordance with TEC12.111(6) this institution is prohibited from discriminating on the basis of sex, national origin, ethnicity, religion, disability, academic, artistic, or athletic ability, or the district the student would otherwise attend in accordance with this code.