2016 summer school application
PULASKI COUNTY SPECIAL SCHOOL DISTRICT SUMMER SCHOOL REGISTRATION FORM
Please check session(s): ___ SESSION I ___ SESSION II
DATE___________________
STUDENT’S NAME_____________________________________________________________Grade____________________ PARENT/GUARDIAN NAME______________________________________________________________________________ PHONE (C) ______________ (W) _________________(PARENT EMAIL) ________________STUDENT DOB:___________ **SCHOOL ATTENDED IN 2015-2016_________________________________________ (must fill out this information) SUMMER SCHOOL DATES: SESSION I: June 20– July 7, 2016 7:30 a.m. – 10:45 a.m. (Monday – Thursday only) SESSION II: June 20– July 7, 2016 11:30 a.m. – 2:45 p.m. High school students: Semester 1 courses will only be offered Session I. Semester 2 courses will only be offered Session II. SITE LOCATION: Mills University Studies High School
1205 E. Dixon Road, Little Rock, AR 72206
COST: $150 per session for resident students (attending a PCSSD school) $300 per session for non-resident students (not attending a PCSSD school) NOTE: All fees must be paid in advance. NO CASH or CHECK PAYMENTS ACCEPTED. Only money order payments will be accepted and are nonrefundable after the first day of each Summer Session. Payment Option #1: Parents can make one payment during the registration period. Payment Option #2: Parents can make partial payments during the registration period. A $50 deposit will be required when submitting the application. The balance is due by the end of the regular registration period. Registration and payment can be made with your school’s bookkeeper until June 20th. Students may earn one credit in summer school. NO WAIVERS WILL BE GRANTED FOR 2016 SUMMER SCHOOL SESSIONS REGISTRATION: Session I/II: May 9 – June 17, 2016 LATE REGISTRATION:
ADD A $50 LATE REGISTRATION FEE AFTER THE DATE ABOVE
___Eng. I
___Eng. II
___Eng. III
___Eng. IV
___Algebra I
___Geometry
___Algebra II
___ Advanced Topics in Mathematics
___Social Studies ________________________ (indicate course) ___Science ________________________ (indicate course) Place a (1) or (2) in the blank beside the course to indicate the appropriate session to be taken.
APPROVED: Counselor Signature__________________________________________________________________________ Parent Signature_______________________________________ Student Signature______________________________________ DO NOT WRITE IN THIS SPACE-FOR SCHOOL USE ONLY Registration Fee $__________ Late Fee $__________Total Fees Due $__________Receipt #_____________ Payment Method: Money Order______ Money Order/Cashier’s Check #__________________________ (NO CASH or Personal Checks) Payment Option: 1 or 2 (Please circle) Amt.____________Receipt #_____________ Payment 1: Date__________Amt.____________Receipt #________________Signature______________________ Payment 2: Date__________Amt.____________Receipt #________________Signature______________________ Payment 3: Date__________Amt.____________Receipt #________________Signature______________________ Payment 4: Date__________Amt.____________Receipt #________________Signature______________________ Scholarship Requested Y___ or N___ Free/Reduced lunch verification attached ______ PLEASE NOTE: If receiving special education services, please contact the SPED Coordinator.
Date_________________
Please check session(s): ___ SESSION I ___ SESSION II
DATE___________________
STUDENT’S NAME_____________________________________________________________Grade____________________ PARENT/GUARDIAN NAME______________________________________________________________________________ PHONE (C) ______________ (W) _________________(PARENT EMAIL) ________________STUDENT DOB:___________ **SCHOOL ATTENDED IN 2015-2016_________________________________________ (must fill out this information) SUMMER SCHOOL DATES: SESSION I: June 20– July 7, 2016 7:30 a.m. – 10:45 a.m. (Monday – Thursday only) SESSION II: June 20– July 7, 2016 11:30 a.m. – 2:45 p.m. High school students: Semester 1 courses will only be offered Session I. Semester 2 courses will only be offered Session II. SITE LOCATION: Mills University Studies High School
1205 E. Dixon Road, Little Rock, AR 72206
COST: $150 per session for resident students (attending a PCSSD school) $300 per session for non-resident students (not attending a PCSSD school) NOTE: All fees must be paid in advance. NO CASH or CHECK PAYMENTS ACCEPTED. Only money order payments will be accepted and are nonrefundable after the first day of each Summer Session. Payment Option #1: Parents can make one payment during the registration period. Payment Option #2: Parents can make partial payments during the registration period. A $50 deposit will be required when submitting the application. The balance is due by the end of the regular registration period. Registration and payment can be made with your school’s bookkeeper until June 20th. Students may earn one credit in summer school. NO WAIVERS WILL BE GRANTED FOR 2016 SUMMER SCHOOL SESSIONS REGISTRATION: Session I/II: May 9 – June 17, 2016 LATE REGISTRATION:
ADD A $50 LATE REGISTRATION FEE AFTER THE DATE ABOVE
___Eng. I
___Eng. II
___Eng. III
___Eng. IV
___Algebra I
___Geometry
___Algebra II
___ Advanced Topics in Mathematics
___Social Studies ________________________ (indicate course) ___Science ________________________ (indicate course) Place a (1) or (2) in the blank beside the course to indicate the appropriate session to be taken.
APPROVED: Counselor Signature__________________________________________________________________________ Parent Signature_______________________________________ Student Signature______________________________________ DO NOT WRITE IN THIS SPACE-FOR SCHOOL USE ONLY Registration Fee $__________ Late Fee $__________Total Fees Due $__________Receipt #_____________ Payment Method: Money Order______ Money Order/Cashier’s Check #__________________________ (NO CASH or Personal Checks) Payment Option: 1 or 2 (Please circle) Amt.____________Receipt #_____________ Payment 1: Date__________Amt.____________Receipt #________________Signature______________________ Payment 2: Date__________Amt.____________Receipt #________________Signature______________________ Payment 3: Date__________Amt.____________Receipt #________________Signature______________________ Payment 4: Date__________Amt.____________Receipt #________________Signature______________________ Scholarship Requested Y___ or N___ Free/Reduced lunch verification attached ______ PLEASE NOTE: If receiving special education services, please contact the SPED Coordinator.
Date_________________
