PENNSYLVANIA, June 22 - for use under subsection (a). The form shall only include:

(1) The current school year.

(2) The name, home address and mailing address of the

student.

(3) The grade in which the student is being enrolled.

(4) The date the student will be enrolled.

(5) The name and address of the cyber charter school.

(6) Parent or guardian information, including:

(i) The name, home address, mailing address,

telephone number and email address of the student's

parents or guardians, as applicable.

(ii) A field to indicate who the student primarily

resides with, including "Both Parents or Guardians,"

"Both Parents or Guardians Alternately," "Parent or

Guardian #1 Only (Primary Parent or Guardian)," "Foster

Parent," "Other Adult" and "Unaccompanied Youth."

(7) The student's school district of residence.

(8) Former school information, including:

(i) A field to indicate the type of school that the

student previously attended, including "School District,"

"Cyber Charter School," "Brick-and-Mortar Charter

School," "Home School" and "Nonpublic or Private School."

(ii) The name and address of the student's former

school.

(iii) Withdraw date from the former school.

(iv) A field to indicate the reason the student was

not enrolled in a school before the cyber charter school

enrollment, if applicable, including "Entering

Kindergarten," "Re-Enrolling Dropout" and "Other."

(9) Proof of residency, which shall be a document

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