NORTHWOODS COMMUNITY CHARTER SCHOOL by jD0fQI

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									      NORTHWOODS COMMUNITY ELEMENTARY SCHOOL

                                Student Application

                              2010-2011 School Year

Student Name ___________________________________________________________
Address ________________________________________________________________
Mailing Address _________________________________________________________
City _________________________ State _________________ Zip_________________
Age ___________ Date of Birth ___/___/___
Current Grade _____ Grade Applying For: _____ Circle One: School Based or Virtual
School Currently Attending ____________________ City of Current School__________
Does your child currently have a special education IEP? _____________


Parent/Guardian Name (1)_________________________Relationship_______________
Address (if different) ______________________________________________________
Home Phone __________________________Work Phone ________________________
Cell Phone ___________________Email Address _______________________________
Parent/Guardian Name (2)_________________________Relationship_______________
Address (if different) ______________________________________________________
Home Phone __________________________Work Phone ________________________
Email Address ___________________________________________________________

Parent Signature ____________________________________ Date _________________

Submit applications to:
Northwoods Community Elementary School (NCES)                 For Office Use Only:
                                                          Application Was Received On:
9086 Highway K
Harshaw, Wisconsin 54529
                                                         _____________________
Or Fax to (715) 282-8218
For more information contact:
Tami Marten, Governing Council Chairperson (715) 282-8200
Kelli Jacobi, Charter School Administrator (715) 365-9700 ext. 5714

								
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