Enrollment Inquiry Form

Interested in learning more about our Enrollment Process? Complete our Inquiry Form below and we'll be in touch soon with additional information for your child!

Steps to complete enrollment:

Please complete the initial inquiry form below to provide us with your contact information. A member of the enrollment team will contact you to introduce you to 21CCCS and answer your questions.
An enrollment packet will be emailed to you following completion of the registration link. You must return the completed enrollment packet, an up-to-date immunization record, proof of age, proof of residency and academic records to the registrar.
Upon receipt of your complete packet, you will receive notification from our registrar of your child's official enrollment in 21CCCS.

Student's Legal First Name: *

Student's Legal Last Name: *

Student's Date of Birth: (MM/DD/YYYY)*

Student's Gender: *

What grade is he/she/they currently in? *

What grade will he/she/they be enrolling in? *

Current school in attendance: *

Student's Email: *

Has this student previously attended 21CCCS? *

Parent 1: *

Parent's Name: *

Street Address: *

Apartment/ Unit:

City: *

State: *

Zip Code: *

Email Address: *

Home/Cell Phone Number: *

Other Phone Number:

Does this person speak English? *

If not English, what is this person's preferred language?

How did you hear about us? *

What day would you prefer to be called? *

What time of day would you prefer to be called? *

Referred By: *

Does your child receive any special service programming (i.e. special education, related services, gifted programs, 504)? Please be as specific as possible. *

Additional questions or comments: