Please note that filling out this form is only the first step in enrollment in CPDLF. If your child is currently enrolled in a school district, DO NOT withdraw from that school district until CPDLF confirms in writing that you have been accepted.
   CPDLF is now accepting applications for
   the  2011- 2012 school year.
Student Information
First Name:

Middle Initial:
(If you do not have a middle name, please input 'X')

Last Name:
Birth Date:
Resident/Local School District:
If your district is not listed, enter it here:
Current Grade
Level :

Parent/Guardian Information (make sure that Parent 1 is a parent / guardian that you currently live with)

 
Parent 1 First Name:
Parent 1 Middle Initial
(If your parent does not have a middle name, please input 'X'):
Parent 1 Last Name:
Parent 2 First Name:

Parent 2 Middle Initial
(If your parent does not have a middle name, please input 'X')::
Parent 2 Last Name:
Current Address:
City:
State:
Zip:
Home Phone:
Alternate Phone:
Email Address:
I hereby make application for the possible admission of my child to the Central Pennsylvania Digital Charter School for school year 2011-2012.