Get Ccaenrollmentnotificationform

Me Warning A child enrolled in another public school or a nonpublic or private school cannot at the same time enroll in a charter school. I. Student Information Last Name First Name MI Home Address City State County Mailing Address Zip Code If different from Date Of Birth Age II. School District of Residence and Former School Information School District of Residence Former School Information Other Than Pre-School Public School Charter School Home School Non-public School Student Not Enrolled in School Preceding Enrollment in Charter School Because Entering Kindergarten Re-Enrolling Dropout Other Name of Former School Address of Former School Previous Grade Withdrawal Date From Former School Was your child receiving Special Education Services based on an IEP If Yes do you have the child s Special Education Records IEP Page 1 of 2 Charter School Student Enrollment Notification Form Yes PDE 2/2008 No III. CHARTER SCHOOL STUDENT ENROLLMENT NOTIFICATION FORM For School Year 2017-2018 Commonwealth Charter Academy Charter School Address One Innovation Way Harrisburg PA 17110 Telephone Email Address 1-844-590-2864 toll free CCACharterForm ccaeducate. me Warning A child enrolled in another public school or a nonpublic or private school cannot at the same time enroll in a charter school. I. Student Information Last Name First Name MI Home Address City State County Mailing Address Zip Code If different from Date Of Birth Age II. School District of Residence and Former School Information School District of Residence Former School Information Other Than Pre-School Public School Charter School Home School Non-public School Student Not Enrolled in School Preceding Enrollment in Charter School Because Entering Kindergarten Re-Enrolling Dropout Other Name of Former School Address of Former School Previous Grade Withdrawal Date From Former School Was your child receiving Special Education Services based on an IEP If Yes do you have the child s Special Education Records IEP Page 1 of 2 Charter School Student Enrollment Notification Form Yes PDE 2/2008 No III. Parent/Guardian Information Both Parents Child Lives With Legal Guardian Special Custodial Court Instructions Alternately Foster Parents Mother Only Father Only Other Adult Yes Provide a copy of Court Order Complete Parent/Guardian Name and Address Information As Applicable Father s Name Address If The Student Is Not Living With Parents Please Complete This Section. Guardian OR Name My signature on this form indicates my decision to have my child attend the charter school named on page 1 of this form and signifies my request that appropriate school records be forwarded from the school district to the charter school. My signature also certifies that my child is not and will not be enrolled in another public school a non-public school or a private school at the same time he or she is enrolled in this charter school. Signature of Parent/Guardian Date IV. School District of Residence and Former School Information School District of Residence Former School Information Other Than Pre-School Public School Charter School Home School Non-public School Student Not Enrolled in School Preceding Enrollment in Charter School Because Entering Kindergarten Re-Enrolling Dropout Other Name of Former School Address of Former School Previous Grade Withdrawal Date From Former School Was your child receiving Special Education Services based on an IEP If Yes do you have the child s Special Education Records IEP Page 1 of 2 Charter School Student Enrollment Notification Form Yes PDE 2/2008 No III. Parent/Guardian Information Both Parents Child Lives With Legal Guardian Special Custodial Court Instructions Alternately Foster Parents Mother Only Father Only Other Adult Yes Provide a copy of Court Order Complete Parent/Guardian Name and Address Information As Applicable Father s Name Address If The Student Is Not Living With Parents Please Complete This Section. Guardian OR Name My signature on this form indicates my decision to have my child attend the charter school named on page 1 of this form and signifies my request that appropriate school records be forwarded from the school district to the charter school. My signature also certifies that my child is not and will not be enrolled in another public school a non-public school or a private school at the same time he or she is enrolled in this charter school. Signature of Parent/Guardian Date IV. To Be Completed By Charter School Birth Certificate Verification of Date of Birth Mortgage Lease Utility Bill Proof of Residency Statement Official Enrollment Date Anticipated Date of Attendance Grade Student Is Entering.