PALM Charter High School

Student Information

1) Student Name

2) Current Grade

3) Date of Birth

4) Address

City, State, Zip

Parent/Guardian Information

5) Parent/Guardian Name

6) Phone Number

7) Email

Current School Information

8) School Name

9) Phone Number

Other Information

10) Has student ever attended a school in Horry County?

Yes

No

11) Name of Horry County School Attended

(only if different from current school)

12) Does Student have an IEP?

Yes

No

Unsure

13) Does Student have a 504?

Yes

No

Unsure

14) Does student have a Behavioral Plan?

Yes

No

Unsure

15) Does this student have any pending litigation/criminal charges

Yes

No

16) If so, what is the nature of the charge(s)? (optional)

17) Has this student attended Horry County Alternative School or Department of Juvenile Justice?

Documentation will be requested

Yes

No

The student referenced above has applied for admission to Palmetto Academy for Learning Motorsports. In order to complete the process, we are requesting all records pertaining to this student.

18) Records Include

NOTE: This is not an official withdrawal form from school because this student may not be accepted or if accepted may not register. We will send an official request confirming the student’s enrollment

Unofficial Transcript

School Discipline Reports

Attendance Reports

504 Plan or IEP

By printing my name below, I give consent for Palmetto Academy for Learning Motorsports to request my student’s school records. This includes any psychological reports, individual education plans, sch

19) Parent/Guardian Signature Signature

I understand that my typed signature is the legal equivalent of my handwritten signature on this document.

20) Date

PALM Charter High School

About

Academics

Students

Parents

Contact

Registration

Pre-Registration Form