Please read all instructions as you complete this form in its entirety. If you have any questions please contact Lou Corominas at 484-875-5464.
*The asterisk fields are required.
*This information is required under certain conditions.
Please enter the following information concerning the student's current or most recent school.
Please share with us information about how you access the internet.
If you currently do not receive internet service, a BeeNet dialup account can be provided for you. If you choose to use BeeNet, you will not qualify for internet reimbursement.
Secondary Parent/Legal Guardian Information
Emergency Contact - In case we cannot reach you.
Please provide contact information for someone other than a parent/legal guardian in the event that you are unreachable.
*Please enter a home or cell phone number for the emergency contact
Home Language Survey
Please be sure to click submit only once.