YOUNG SCHOLARS OF WESTERN PA CHARTER SCHOOL
Online Student Application Form
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  DEAR PARENTS AND APPLICANTS:
  Thank you for your interest in Young Scholars of Western PA Charter School. Please fill out this application form completely. Falsifications, misrepresentations or omissions may disqualify your application.
   
   Applicant's Personal Information
   
      Year Applying: *
  Grade Applying: *
  Last Name: *
  First Name: *
Middle Name:
  Suffix:
  Date of Birth: *
  Gender: *
  State/City of Birth:
  Country of Birth:
  Resident Country:
 
   Applicant's School Information
   
  Current School: *
  School District: *
  School Address:
  School Phone:   XXX-XXXXXXX
  School Fax:   XXX-XXXXXXX
  Years Attended From:   *
 
   Applicant's Family Information
   
  Applicant lives with: * If Other  
         
  Primary Parent: * If Other: *
  Title:    
  First Name: * Last Name: *
  Street: *
  City: * State:      Zip:
  Home Phone: * Work Phone:
  Cell Phone: Email: *
         
  Secondary Parent: If Other :
  Title:    
  First Name: Last Name:
  Street:
  City: State:      Zip
  Home Phone: Work Phone:
  Cell Phone: Email:
         
         
   How did you hear about Young Scholars of Western PA Charter School ?
   
   
       
           
  Please briefly state why you wish to have your child enrolled at Young Scholars of Western PA Charter School.  
   
 
We hereby certify that, to the best of my/our knowledge and belief, the answers to the foregoing questions and statements made by me/us in this application are complete and accurate. I/We understand that any false information or misrepresentations of facts may result in rejection of this application or future dismissal of the applicant. We hereby certify that, to the best of my/our knowledge and belief, the answers to the foregoing questions and statements made by me/us in this application are complete and accurate. I/We understand that any false information or misrepresentations of facts may result in rejection of this application or future dismissal of the applicant.