Editing previous response:

Please fix the highlighted areas below before submitting.

Panola Charter High School

PS Logo

Student Information

School Year Applying For:*

Answer required for "School Year Applying For:"

2024-25

2025-26

First Name:*

Answer required for "First Name:"

Middle Name

Answer required for "Middle Name"

Last Name*

Answer required for "Last Name"

Date of Birth:*

Answer required for "Date of Birth:"

Gender:*

Answer required for "Gender:"

Male

Female

Student Cell Phone:

Number Required

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

Parent/Guardian Information

First Name:*

Answer required for "First Name:"

Last Name:*

Answer required for "Last Name:"

Relationship to Student:*

Answer required for "Relationship to Student:"

Father

Mother

Grandparent

Other:

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

Email Address:*

Answer required for "Email Address:"

Cell Phone:*

Number Required

Work Number:*

Number Required

CERTIFICATION (Required): 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 am the legal guardian of the child listed above, and 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.*

Answer required for "CERTIFICATION (Required): 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 am the legal guardian of the child listed above, and 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."

I Agree

Confirmation Email

Answer required for "Confirmation Email"