ENROLLMENT ASSESSMENT FORM
Enrolling Parent/Guardian/Caregiver
Address
City
State
ZIP
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Relationship to Student
Contact Number
** Please Select **
AUNT
BROTHER
BROTHER IN LAW
FIANCE
FOSTER FATHER
FOSTER MOTHER
FRIEND
NEIGHBOR
NEPHEW
NIECE
SIGNIFICANT OTHER
COUSIN
SISTER IN LAW
DOCTOR - Type
EMERGENCY CONTACT - Type
LEGAL GUARDIAN
Household Member
NA
Spouse
Son
Parent
Placement Provider (Tuscaloosa County DHR)
Mobile DHR social worker
Legal Guardian
Great Grandmother
God Mother
Granddaughter
Daughter
STEP BROTHER
STEP SISTER
FATHER
MOTHER
STEP FATHER
STEP MOTHER
GRANDFATHER
GRANDMOTHER
CAREGIVER
CASE WORKER
SISTER
SOCIAL WORKER
UNCLE
Legal Guardian
Address
City
State
Zip
** Please Select **
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
I have petitioned the court for legal custody
Student's parent/legal guardian is in military on deployment
I am a student who is NOT living with a legal parent/guardian
Student was placed with me by an agency (DHR, DYS, etc)
I am living in a temporary housing situation
Other
Other Description
Please explain the current situation (living, custody, etc.):
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