<p> Huntington Charter School New Student Dormitory Application</p><p>District policy stipulates that only students enrolled in grades 9-12 will be allowed to live in dormitory. </p><p>We look forward to hearing from you and receiving your application materials. Applications will be screened by the Dormitory Residence Committee in the order they were received. Approved applicants will be notified by phone or mail. Upon approval the district may require additional information from the student and their legal guardians. </p><p>If you have any questions please feel free to contact the District Office at (541) 869-2204 or visit our website at http://www.huntington.k12.or.us/home</p><p>Please provide an answer to all questions and provide as much detailed information as possible to assist the screening committee with their decision. Incomplete applications, false information, and/or failure to provide adequate information may result in your application being rejected.</p><p>Upon completing the application please submit it to the following:</p><p>Huntington Charter School</p><p>Attn: Shelley Guerri</p><p>520 Third Street East</p><p>Huntington, OR 97907</p><p>Or </p><p>[email protected] Student Information</p><p>Student Name:</p><p>______</p><p>Last First Middle</p><p>Date of Birth: (mm/dd/yyyy) ___/_____/______Sex: ___ Male ___ Female</p><p>Home Phone: (____)______Cell: (____)______Emergency: (____)______</p><p>Home Address: ______</p><p>Street City</p><p>______</p><p>State Zip</p><p>Email Address: ______</p><p>Parent/Guardian Information</p><p>Fathers Name: ______</p><p>Fathers Occupation: ______</p><p>Fathers Home Phone: (_____)______Fathers Cell: (_____)______</p><p>Fathers Address: ______</p><p>______</p><p>Mothers Name: ______</p><p>Mothers Occupation: ______</p><p>Mothers Home Phone: (_____)______Mothers Cell: (_____)______Mothers Address: ______</p><p>______</p><p>In case of emergency contact: ______(_____)______</p><p>Previous School Information</p><p>Name of School Previously Attended: ______</p><p>Grade Level: ______GPA: ______</p><p>School Address: ______</p><p>Street City</p><p>______</p><p>State Zip</p><p>School Phone: (_____)______</p><p>List the high school or community activities in which you participated:</p><p>______</p><p>______</p><p>Huntington Charter School Information The Huntington Charter School strongly encourages all dormitory students to participate in school related activities, community activities, school sponsored athletics, and other extracurricular activities. Please list activities in which you plan or have interest in participate in during the school year:</p><p>______</p><p>Areas of Academic Interests</p><p>______</p><p>Dormitory Rules and Contract</p><p>Please read the Huntington Dormitory Contract and Rules by clicking the link found on the “Huntington Dormitory” link. Please check the box below to indicate that you have read and agree to abide by the guidelines and policies outlined. This box must be checked or your application will not be accepted.</p><p> I have read and agree to abide by the terms of the 2016-2017 Huntington Dormitory Rules and Regulations and other District Policies regulating the behavior and conduct of students. I understand that by violating any rules, regulations, or district policies I will be subject to disciplinary action and possible expulsion from the dormitory. </p><p>______Parent/Guardian Signature Date</p><p>______</p><p>Parent/Guardian Signature Date</p><p>______</p><p>Student Signature Date</p>