2008-2009 Application of Intent


Directions: Please complete the following form for each student intending to enroll.

If you plan to enroll more than one student, submit this for your first student, then complete another form for each additional student.

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Student's Name:
  
Age:
  
Birth Date:
  
Parent/Guardian Name:
  
Address:
  
Address 2:
 Apt. # P.O. Box
City:
  
State:
  
Zip:
Home Phone Number:
  
Cell Phone Number:
  
E-mail Address
  
Current School:
  
Grade Student Will Enter in 2008-2009:

Please check all that apply:

How did you learn about PALCS? Please check ALL that apply.
Word of mouth
Another student/family in PALCS
My current school (guidance counselor, principal, etc.)
An internet search (Google or other)
The PA Department of Education Website/other website
A radio advertisement
A print advertisement
A news article
Saw the Pittsburgh Mills Office
Other (please specify)
 
 

 

 

  
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