ENROLLMENT ASSESSMENT FORM
Enrolling Parent/Guardian/Caregiver Address City State ZIP
                
   
Relationship to Student Contact Number
        
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 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.):