ENROLLMENT

 
 
Please complete all
required fields.

When finished, click the "Submit Enrollment" button below.
 
   
   
Items with an asterisk (*) are required.

The first deadline for this enrollment application is May 31, 2010, for the 2010-2011 academic year. If we receive more applications than we can accommodate, we will hold a lottery for admission on June 1, 2010. Students who apply after the May 31 deadline will be admitted on a first come, first served basis if space is available. Every student must reapply for enrollment to KIPP Delta Schools every year if the student is not selected in the June 1, 2010, lottery. Applications for enrollment do not carry over from year to year. 		 
   
Student Information  
Student First Name *
   Student's Last Name *
Entering Grade Level *
   Current School *
Please select the academic year for which you seek enrollment *
School for which enrollment is sought *
Home Address    
Street Address *
  Address Line 2
City *
  State *
Zip Code *
   
Parent/Guardian Information
Parent/Guardian First Name *   Parent/Guardian Last Name *
 
Parent/Guardian Home Phone *   Parent/Guardian Work or Cell Phone *
 
Parent/Guardian Email Address
   What is your relationship with the student? *
What is the best way to
contact you? *
   Will the student need bus transportation? *
Yes No
Does your child have a sibling at KIPP? If so, please write their name here:
Other
Do you know of another student who may be interested in KIPP next year? Please write their name here:
  Interested student's current grade:
Interested Student's Parent:
   Interested Student Parent's Phone:
How did you hear about KIPP Delta Public Schools? *
  If "other," please tell us how:
     
     
     
 
 
 
    415 Ohio Street, Helena-West Helena, AR 72342
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Photography provided by: Ethan Pines & Cade Collister/Southern Bancorp