Registration

Open Enrollment

PRE-APPLICATION FOR ENROLLMENT

A YOUTH CONNECTION CHARTER SCHOOL CAMPUS

Application Date*
MM
DD
YYYY
Name
First Name Middle Name Last Name
Date of Birth*
MM
DD
YYYY
Current Grade **
CPS ID*
Email*
Address w/ Apt# **
Address
City State / Province / Region
Zipcode **
Work Phone*
Home/Cell Phone*
Emergency Contact Name*
Emergency Contact Relationship*
Emergency Contact Phone Number*
Prior School **
Currently Enrolled?*
- Yes
- No
Number of Credits **
How did you hear about us?