SHILOH CHARTER SCHOOL

Shiloh Charter School
2010-2011 Student Application
Please read the following carefully before completing the application
Do not submit more than one application per child. Duplicate applications will not be processed.
Do not submit an application for a child who is not age eligible. These applications will not be processed.
Applicants for Kindergarten must be 5 years old on or before September 1, 2010.
All applicants will be notified by mail of their acceptance.


Please select the grade that your child will be entering in August 2010 (*)
Please SelectKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEighth Grade


Student Information:

Student First Name (*)

Please type your full name.
Student Middle Name

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Student Last Name (*)

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Student ID Number

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Student Date of Birth (*)

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Gender
MaleFemale
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Name of Current School

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If not a Hillsborough County School, please provide the address:

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Student Services:

Is the student receiving any special instruction or services as a result of an IEP? (*)
NoYes
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Is the current education plan modified according to Section 504 Plan? (*)
NoYes
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Does the student require instruction for ESOL (English Speakers of Other Languages)? (*)
Noyes
Invalid Input

Parent/Legal Guardian Information:

Parent / Guardian First Name (*)

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Parent / Guardian Middle Name

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Parent / Guardian Last Name (*)

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Parent / Guardian Mailing Address (*)

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Parent / Guardian City (*)

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Parent / Guardian State (*)

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Parent / Guardian Zipcode (*)

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Parent / Guardian Home Phone (*)

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Parent / Guardian Work Phone

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Parent / Guardian Mobile Phone

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Parent / Guardian Email Address (*)

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Sibling Information

Will a sibling of this applicant be applying to this school for the 2010 - 2011 school year? (*)
YesNo
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Please note: A separate application must be completed for each student wishing to attend the school August 2010


If yes, please indicate the name and grade level of the sibling/siblings

Sibling Name

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Sibling Grade
Please SelectKindergartenFirst GradenSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh Grade
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Sibling Date of Birth

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Sibling Name

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Sibling Grade
Please SelectKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh Grade
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Sibling Date of Birth2

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Sibling Name

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Sibling Grade
Please SelectKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh Grade
Invalid Input
Sibling Date of Birth3

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To the best of my knowledge, the above information is accurate and complete. In the event of a change of address, phone number, name, etc.: I will notify the school.

Parent name completing the online application (*)

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Thank you for completing this online application for your child to attend the Shiloh Middle Charter School during the 2010 - 2011 school year. You will receive an email confirmation after you click the Submit button below.