Kornerstone School Student Application www.kornerstoneschool.

org

Enrollment Procedures:
1. Application forms can be obtained from Kornerstone School, the Kimberly Area
School District Administrative Building, or Kimberly High School/JR Gerritts Student
Services Offices and returned to Kimberly High School, Attention: Michael McCabe,
Kornerstone School Lead Teacher.

2. Families interested in Kornerstone School who live outside of the School District of
Kimberly will also need to file the necessary paperwork for open enrollment. Procedures
for doing this can be found on the State of Wisconsin Department of Public Instruction
Website (see link) http://dpi.wi.gov//forms/doc/f9410.doc

3. Once students are notified of their acceptance, they will be scheduled for an initial
interview to discuss their learning style and academic goals.

*If more students apply than enrollment spots, openings will be filled by a random
lottery drawing and not on a first come, first served basis

*If needed, the Lottery will be held on Tuesday, May 24, 2011

STUDENT
Name: _____________________________________ Date of Birth: ___________________
Address: __________________________________________________________________
Phone: _______________________ Cell Phone: __________________________________
School: _______________________ Grade: _________ Graduation Year: ______________

PARENTS or Guardian Preferred Email __________________________

Father: _____________________________ Address: ______________________________

Home Phone: ____________ Work Phone: _____________ Cell Phone: _______________
Mother: _____________________________ Address: _____________________________
Home Phone: ____________ Work Phone: _____________ Cell Phone: _______________
Willing to volunteer at school: ______ Yes ______ No

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