Registration Forms

Click on the button below to open the registration form that pertains to you.

Application Forms

Student’s Name *

Middle Name *

Last Name (Family Name) *

Preferred Name

Applying to grade *

for entrance in (Month/Year) *

Gender *

Male
Female

Religious Affiliation *

If permanent address is in the United States, please complete this section:

City

State

Zip Code

Ethnicity *

If permanent address is outside of the United States, please complete this section:

Postal Code, City/Town/Locality

Country:

Home telephone

Student Cell Phone *

Student Email

Citizenship *

Student Personal web space (e.g. blog, Facebook, etc.)

Birthplace: Country

State/Province

City

Zip

US Citizen

If not a US, Citizen, What is your Citizenship?

Date of Birth

MM/DD/YYYY

Student’s Social Security Number

SCHOOL Information

School phone

School address

Current Residence School District:

Previous schools attended by Student

Household 1: Parent(s)/Guardian(s) who live with Student

Married
Separated
Divorced
Single Parent

Parent 1 Name

Parent 1 Relation to Student

Is an emergency contact
Is financially responsible

Parent 1 Home Phone

Parent 1 Cell

Parent 1 Email

Parent 1 Occupation

Parent 1 Title

Parent 1 Employer

Parent 1 Bus. Phone

Spouse 1 Name

Spouse 1 Relation to Student

Is an emergency contact
Is financially responsible

Spouse 1 Home Phone

Spouse 1 Cell

Spouse 1 Email

Spouse 1 Occupation

Spouse 1 Title

Spouse 1 Employer

Spouse 1 Bus. Phone

Please state household 1 annual income

List siblings and grade level:

Household 2 (if applicable): Parent(s)/Guardian(s) who live with Student

Married
Separated
Divorced
Single Parent

Parent 2 Name

Parent 2 Relation to Student

Is an emergency contact
Is financially responsible

Parent 2 Home Phone

Parent 2 Cell

Parent 2 Email

Parent 2 Occupation

Parent 2 Title

Parent 2 Employer

Parent 2 Bus. Phone

Spouse 2 Name

Spouse 2 Relation to Student

Is an emergency contact
Is financially responsible

Spouse 2 Home Phone

Spouse 2 Cell

Spouse 2 Email

Spouse 2 Occupation

Spouse 2 Title

Spouse 2 Employer

Spouse 2 Bus. Phone

Please state household 2 annual income

The search for a new school was initiated by:

What initiated the search for a new school?

From what source did your family first learn about Pillsbury College Prep?

Please describe your child’s academic strengths and weaknesses

Please describe your child’s relationships with his or her peers

What are your goals for your child?

Please describe your child’s relationship with his or her family

What are you child’s particular interests and talents?

Please list your childs involvement in sports, arts, extracurricular activities, community service, volunteer projects, and or church projects .

Are there aspects of your child’s personal, physical, or emotional life which you would like to see strengthened during his or her school experience?

Has your child ever had an education evaluation?

Has your child ever received counseling?

If you checked yes to either of these questions, please explain the circumstances. Though sensitive, this information deserves your candor so that we may better serve your child.

Number of days absent from school during the most recent school year:

Has your child ever been suspended/expelled from school?

Is your child in the process of being suspended/expelled from school?

Is there any other information that you wish to have considered by PCP?

Math Teacher's name

Math Teacher's email

Transcript Release Form

Confidential Recommendation Form

TO THE PARENT/GUARDIAN To complete your child’s application, it is necessary that we receive a copy of his/her official school transcript. In order to facilitate this process, we request that you sign the release statement below. Please present this page to your child’s principal, head of school, or advisor.

Student’s Name

First Name (Given Name)

Middle Name

Last Name (Family Name)

I hereby authorize that my child’s school transcript records and any relevant standardized test results be released to Pillsbury College Prep, 315 South Grove Avenue, Suite 1, Owatonna, MN 55060.

Parents Full Name:

Parent’s signature

Date *

MM/DD/YYYY

TO THE SCHOOL The student listed above is a Student for admission to Pillsbury College Prep. To complete his/her application we require a complete, official transcript of his/her grades and standardized testing from 6th grade to present

Thank you for your cooperation.

Message

Application to Enroll by Proxy

PERSONAL DETAILS *

Child’s Family Name

. *

Given Name

Programs Attending:

Pillsbury College Prep
Camp Pillsbury

SECTION 1 – TO BE COMPLETED BY THE STUDENT *

(Full Legal Name of parent or guardian)

hereby appoint (name of proxy)

of (company name)

to handle all affairs and complete all necessary documents required to enroll my dependent in:

Pillsbury College Prep
Camp Pillsbury

I accept responsibility for all actions carried out on my behalf by my authorized proxy (including decisions related to fees).

Signature of Parent/Guardian:

Date *

MM/DD/YYYY

SECTION 2 – TO BE COMPLETED BY THE PROX

I (name of proxy)

hereby agree to act as the proxy for (name of student)

for the enrollment, completion of all necessary documents to Pillsbury College Prep and/or Camp Pillsbury, and the handling of all affairs which will be carried out including decisions related to fees.

Signature of proxy:

Date

MM/DD/YYYY

Message

BOARDING SCHOOL REGISTRATION FORM

PROXY FORMS