ENROLLMENT ASSESSMENT FORM

Enrolling Parent/Guardian/Caregiver
    
Address
    
City
    
State
   
ZIP
    
Contact Number
    
Relationship to Student
   

Legal Guardian
    
Address
    
City
    
State
Zip
    
Contact Number
    
I am seeking to enroll the above named student for the following reason(s): (Check ALL that apply)
Student's parent/legal guardian is incarcerated/in jail
Student's parent/legal guardian is in military on deployment
Student was placed with me by an agency (DHR, DYS, etc)
I have petitioned the court for legal custody
I am a student who is NOT living with a legal parent/guardian
I am living in a temporary housing situation
Other
Other Description  
Please explain the current situation (living, custody, etc.):
First Name     
Last Name     
Race
Gender    
DOB
    
Student Grade Level    
Last School Attended  
Social Security # or Student #
 
Zone Location    

  Click here to Add more of your student's
I am seeking to enroll the above named student for the
following reason(s): (Check ALL that apply)


I hereby attest that the information above is true and correct and
I understand that if I falsely enroll the student named above
in a school not in his/her proper attendance zone, the student
may be denied any credit for school work completed while
improperly attending the out-of-district school.


 
Submitted Date