Addmission Form

Primary Guardian

First Name

Last Name

Secondary Guardian

First Name

Last Name

Street Address

City

State

Zip Code

Mobile Phone

Work Phone

Home Phone

*You must have a valid email account so we can contact you. Please create free email account at: http://mail.google.com or http://mail.yahoo.com

Main Email Address

Alternate Email Address

In what PUBLIC School District do you currently reside and Name of the school?

How did you hear about us?

Why did you select PTAA?

Please enter names of up to six students: (Names should match birth certificate)

*Discipline: Does the applicant have any documented history of discipline problems, criminal offense, juvenile court adjudication, or removal to an alternative education program for cause or expulsion? PTAA has the right to exclude students with documented histories of a criminal offense, juvenile court adjudication, or discipline problems

Yes No

First Name Last Name Gender DOB Discipline* Campus* Grade Action

Twins, Triplets or other Multiple Births

Does this child have a twin or triplet or other multiple birth?

Yes No

Other Siblings Applying to PTAA

Does this applicant have a brother or sister, other than a twin, triplet, or multiple birth, who is also applying to a PTAA School?

Yes No

Siblings Currently Attending PTAA

Does this applicant have a brother or sister currently in a PTAA School?

Yes No

PTAA Connections

Is the parent a PTAA faculty member?

Yes No

For Informational purposes only (does not impact lottery priority)

Is the student a brother or sister of a PTAA alumna or alumnus?

Yes No

School Communications

YES! I would like to stay connected via the PTAA newsletter.

YES! I would like to get text reminders about key important dates.

For lottery communications, If I can't be reached, call this person

*Name

*Phone

I CERTIFY: By checking this box, I certify to the best of my knowledge and belief that the information in this application is complete and accurate. I understand that any false information, omission, or misrepresentation of facts may result in the rejection of this application or future dismissal of the applicant(s).

Agreement and Signature

Submitting this application does not mean or guarantee that the application will be accepted. By completing this application correctly and notifying us of changes, we guarantee that you will be contacted if the application is accepted through our random lottery process. If the application is accepted because you submitted false, incorrect or misleading information, we may refuse to enroll the student.

By signing your name below and submitting this application, you are agreeing that the information you provided is true and correct.

I agree that the information I provided is true and correct.

*Parent Signature

*Date

PTAA 2021-2022 School Year Student Application

Twins, Triplets or other Multiple Births

Other Siblings Applying to PTAA

Siblings Currently Attending PTAA

PTAA Connections

For Informational purposes only (does not impact lottery priority)

For lottery communications, If I can't be reached, call this person

Agreement and Signature