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Portland Village School A Public Charter School Student Admission Application 2019-2020

Please complete the form below. Required fields marked with an asterisk *
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Parent/Guardian Information:

PVS Application 2019-2020

My child is currently enrolled in or at:*
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The following questions about ethnicity and race are optional.  Your answers will help us focus on future outreach efforts and to make sure underrepresented groups are able to access the school.

What is your Ethnicity or Origin? Mark as many boxes as appropriate*
Answer Required
State and federal standards require that you choose a single identity. Please choose one racial identity*
Answer Required
My child is currently enrolled in the following programs and/or recieves the following services:
Answer Required
Is your child part of a historically underserved group per ORS 338.125? (please check all that apply)
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By signing below you are certifying that you understand the following:

  • All of the information I have provided is current and correct.
  • I authorize the release of my child's school records to Portland Village School once enrolled.
  • I authorize PVS staff tocontact my child's current and/or past school/teacher(s).
  • I understand all of the information disclosed on this application is kept confidential.
  • All of our contact information is current; it is my responsibility to contact the Front Office with any changes to our contact information.
  • I understand that it is my responsibility to ensure that the school has recieved my application.
  • I understand that it is my responsibilityto provide copies of two documents showing proof of residence (defined as utility bills and/or official pieces of identification) and a birth certificate/passport with this application for it to be valid.
Please attach birth certificate or passport of child and two proofs of residency below.
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