Philadelphia Auto & Parole

5224 Woodland Avenue, Philadelphia, Pennsylvania 1914

Telephone: 1(855)726-5226

To be considered for admission to Philadelphia Auto & Parole all sections of this application must be completed and handed in by the given due date. Admission into our program is contingent upon successful completion of the application, interview process, and final receipt of all records. Incomplete applications will not be processed.

Student Name: (Last/First/Middle)

PARENT/GUARDIAN SECTION

Parent/Guardian Name: (Last/First/Middle)

GUIDANCE COUNSELOR SECTION

Please submit the transcripts of grades, attendance, and behavior as required by the PAPR. As a guidance counselor, please place any comments/remarks on each transcript that you feel need explanation.

Guidance Counselor Name: (PRINTED)

SIGNATURE SECTION

The statements and information furnished by the undersigned in this application form are true and complete.

The undersigned applicant’s parent(s)/guardian(s) give permission for representatives of the sending school to release the applicant’s records including, grades, attendance, conduct/discipline records, as well as any other pertinent information that may be required by Philadelphia Auto and Parole for the purpose of admission.

Our signatures certify that we have read and agree with the above statements.

Student Signature: (PRINTED Full Name)