Pacific Community Charter High School 200 Lake Street * PO Box 984 * Point Arena, CA 95468 * (707) 882-2298 * fax (707) 882-2419

2017-2018 ENROLLMENT APPLICATION Student Name: _________________________________________________________________ First

Grade Entering ___________

Middle

Last

Date of Birth ________________

Age _______

Family Mailing Address _______________________________________________________________ Family Physical Address _______________________________________________________________

Check all the following that apply:  Sibling of currently enrolled student (Name of current student) __________________________  Child has been on PCCHS waiting list for 2 or more consecutive quarters  Student lives in Arena Elementary District

Parent / Guardian Name __________________________________________ Relationship to Child _________________ Residence Telephone ____________________ Work Telephone ______________________ E-mail ___________________________________________ Signature: ____________________________________________

Date: ___________________

When you have completed the form, please return it to PCCHS by April 7, 2017 by 5:00 pm by either: 1. Completing and signing this application and emailing a copy to [email protected] or; 2. Completing and signing this application and faxing it to 882-4132 or; 3. Completing and delivering by hand to the administrative offices of PCCS at 10 Lake St., Point Arena or; 4. Completing and mailing this form to PCCS, PO Box 984, Point Arena, CA 95468 or; 5. Return this form to a member of the Enrollment Committee at one of the scheduled orientation meetings, or in the course of its outreach duties.

If you have any questions regarding this form please call (707) 882-2298. This form must be completely and accurately filled out for your child to be considered for enrollment at PCCS.

Excerpts from Pacific Community Charter School’s Enrollment Policies and Procedures Enrollment in Pacific Community Charter School (PCCS) is open to any child who lives in the State of California, subject to the PCCS’s total enrollment limitations. All enrollments must be ratified by the Governance Council (GC). Conditions of Enrollment 1. Child wishing to enroll in PCCS must be at least five (5) years of age by Oct. 1st of the enrollment year. 2. No enrolling student shall be more than 18 years of age. 3. The family of the enrolling student shall have attended an Orientation Meeting or equivalent as described in the Enrollment Policy. 4. Enrollment forms shall be complete and accurate. 5. The parent(s)/guardian(s) of the enrolling student shall have signed a Family Participation Agreement. 6. The enrolling student shall have signed a Student Conduct Agreement. 7. If an enrolling student has been receiving special education services on an active IEP, enrollment will be considered provisional until a pre-placement IEP meeting can be held to determine appropriate placement. Applications will only be valid if: a) delivered to the administrative office of PCCS at #10 Lake St., Point Arena, b) mailed to PCCS, PO Box 984, Point Arena, 95468 with a postmark on or before the last day of open enrollment, or c) returned to a member of the Enrollment Committee at one of the scheduled orientation meetings, or in the course of its outreach duties. Per our charter petition, the enrollment process recognizes preferences for enrollees in the event that enrollment applications exceed capacity. Preferences, to the extent allowed by law, include the following: Group 1. Currently enrolled students who live within Arena Union Elementary School District (AUESD). Group 2. Currently enrolled students who live outside AUESD. Group 3. Siblings of children in groups 1 and 2, and children of formation committee members who live in AUESD. Group 4. Siblings of children in groups 1 and 2, and children of formation committee members who live outside AUESD. Group 5. Students who live inside AUESD and have been on the PCCS waiting list for 2 or more consecutive quarters. Group 6. Students who live outside AUESD and have been on the PCCS waiting list for 2 or more consecutive quarters. Group 7. All others who live inside AUESD. Group 8. All others who live outside AUESD.

If the number of applicants in the group is equal to or less than the number of available openings, all applicants in the group will be admitted. The number of openings will then be reduced by the number of admissions, and the next group will be considered, until all openings are filled. If the number of applicants is greater than the number of openings, a public random drawing of applicants in the group will be held to determine which applicants will be admitted to those openings. Applicants who are not admitted will be appended to a waiting list for that grade/class in the order in which they were drawn. The number of openings will be reduced to zero. PCCS will inform families added to the waiting list of their placement on the list. Positions on the waiting list are permanent until an enrollment position becomes available. When an enrollment position becomes available, the family of the first student on the waiting list for that class/grade level shall be contacted about enrolling their child. Students who do not enroll when their lottery position becomes available may request placement at the bottom of the current year waiting list. Positions on the waiting list are only valid for the current academic year. Families who wish to be considered for enrollment in the new academic year must reapply, and will be contacted prior to open enrollment. During the school year, applications for enrollment are accepted at any time. If space is available in that child’s grade/class, that child may be enrolled upon completion of all necessary enrollment forms. If no space is available in that grade/class at the time of application, that child’s name will be placed at the bottom of the current waiting list for that grade/class.