Mid-Year Transfer Admission Application 2021-22

Please complete the form below. Each student requires a separate application. Required fields marked with an asterisk *

Student's Name*

Answer Required

Grade Entering in September 2021*

Answer Required

Student's current grade*

Answer Required

Street address*

Answer Required

City*

Answer Required

State*

Answer Required

Zip code*

Answer Required

Date of Birth (must be 5 years old on or before 9/1/2021 if applying for kindergarten)*

Answer Required

Gender*

Answer Required

Female

Male

Non-Binary/3rd Gender

Prefer to self-describe

Name and Grade of CURRENTLY ENROLLED SIBLING, if applicable:

Answer Required

Name and Grade of ADDITIONAL STUDENT APPLICATIONS submitted, if applicable:

Answer Required

Parent/Guardian Information:

Parent/Guardian 1 Name*

Answer Required

Parent/Guardian 2 Name*

Answer Required

Street address (if different from student)

Answer Required

Email Address 1*

Answer Required

Email Address 2*

Answer Required

Phone 1 (Required)*

Answer Required

Phone 2 (Required)*

Answer Required

My child is currently enrolled in or at:*

Answer Required

How did you hear about PVS?*

Answer Required

Friend

Google Search for Waldorf Education

Google Search for Alternative Education

PVS Website

Reside Near PVS

Other:

Portland Village School does not discriminate against any person on the basis of race, color, national origin, creed, religion, sex, ethnicity, sexual orientation, mental or physical disability, ancestry, athletic ability, special needs, English language proficiency, or academic achievement in admission or participation in its programs, services, activities or employment.

PVS Equitable Lottery Demographic Information Form

Historically underserved students who meet at least two of the four identified historically underserved criteria will be entered into the lottery three times (as opposed to one time for other students):

Historically underserved students based on race (includes only: African American, Pacific Islander/Native Hawaiian, American Indian/Alaska Native)
Historically underserved students based on ethnicity (includes only Hispanic)
Economically disadvantaged students (Directly Certified/Free and Reduced Price Meals Program & Head Start)
English language learners

Answering the following questions about race, ethnicity, socioeconomic status and language is optional. Your answers will help PVS determine your student's status for the weighted lottery.

Is your child part of a historically underserved group per ORS 338.125? Please check ALL that apply:

Answer Required

Race

Ethnicity

Socioeconomic status

English language proficiency

What is your child's race? Please check ALL that apply:

Answer Required

African American / Black

American Indian / Alaska Native

Native Hawaiian / Pacific Islander

Decline to answer

Other:

What is your child's ethnicity or origin?

Answer Required

Hispanic / Latino

Decline to answer

Other

My child is currently enrolled in the following programs and/or receives the following services:

Answer Required

ELL (English Language Learner)

Free & Reduced Lunch

Head Start

By signing below you are certifying your agreement to the following:

I authorize the release of my child's school records to Portland Village School once enrolled.
I authorize PVS staff to contact 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.
I understand that it is my responsibility to ensure that the school has received my application.
I understand that it is my responsibility to provide copies of two documents showing proof of residence (defined as utility bills and/or official pieces of identification) and passport or birth/baptismal certificate with this application.

Please (print) sign your name as your signature below.*

Answer Required

Please attach photo of passport, birth certificate or baptismal certificate of child AND two proofs of residency below.

Answer Required

Choose a file or drag it here.

DUE DATE: Monday, April 5th, 2021

(Applications may be submitted after 4/05/21 and will be considered late applications.)

Please direct application and Admissions questions to:

Email: [email protected]

Please fix the highlighted areas below before submitting.

Mid-Year Transfer Admission Application 2021-22