ENROLLMENT ASSESSMENT FORM
Enrolling Parent/Guardian/Caregiver
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Relationship to Student
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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
** Please Select **
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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.):
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5 (18 pt)
6 (24 pt)
7 (36 pt)
First Name
Last Name
Race
** Please Select **
AMERICAN INDIAN/ALASKAN NATIVE
ASIAN
BLACK/AFRICAN AMERICAN
HISPANIC
Multi
NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER
NOT ASSIGNED
WHITE
Gender
** Please Select **
Female
Male
Non-Binary
DOB
Student Grade Level
** Please Select **
01
02
03
04
05
06
07
08
09
10
11
12
K
PK
Last School Attended
Social Security # or Student #
Zone Location
** Please Select **
Allentown Elementary School
Alma Bryant High School
Anna F Booth Elementary School
Augusta Evans School
Baker High School
Ben C Rain High School
Bernice J Causey Middle School
Booker T Washington Middle School
Breitling Elementary School
Burns Middle School
Calcedeaver Elementary School
Calloway Smith Middle School
CF Vigor High School
Chastang-Fournier Middle School
Citronelle High School
CL Scarborough Model Middle School
Clark-Shaw Magnet School
Collins-Rhodes Elementary School
Continuous Learning Center
Cora Castlen Elementary
Dauphin Island Elementary School
Dawes Intermediate School
Denton Magnet School of Technology
Dixon Elementary School
Dr. Robert W. Gilliard Elementary
Dunbar Creative Performing Arts
Eichold-Mertz School of Math and Science
Elizabeth Fonde Elementary School
Elsie Collier Elementary School
ER Dickson Elementary School
Erwin Craighead Elementary School
Evening Educational Options
Florence Howard Elementary School
Forest Hill Elementary School
George Hall Elementary School
Goodwill Easter Seal Center Special Child
Grand Bay Middle School
Grant Elementary School
Hollingers Island Elementary School
Holloway Elementary
Hutchens Elementary School
Indian Springs Elementary School
J E Turner Elementary
John L Leflore Magnet School
John Will Elementary School
Just 4 Development Laboratory
Kate Shepard Elementary School
Katherine H Hankins Middle School
Leinkauf Elementary School
Lillie B Williamson High School
Lott Middle School
Mary B Austin Elementary School
Mary G Montgomery High School
Mary W Burroughs Elementary School
Maryvale Elementary School
Mattie T Blount High School
McDavid-Jones Elementary School
Meadowlake Elementary
Mobile County Training Middle School
Mobile Mental Health Center
Morningside Elementary School
Murphy High School
Nan Gray Davis Elementary School
North Mobile County Middle School
Not Assigned
O'Rourke Elementary School
Old Shell Road Magnet School
Olive J Dodge Elementary School
Orchard Elementary School
Pearl Haskew Elementary
Peter F Alba Middle School
Phillips Preparatory Middle School
Pillans Middle School
Saint Elmo Elementary School
Semmes Elementary School
Semmes Middle School
Spencer-Westlawn Elementary School
SW Alabama Regional School Deaf-Blind
Tanner Williams Elementary School
Taylor White Elementary School
The Pathway
Theodore High School
TL Faulkner School
UCP Of Mobile Inc
W H Council Traditional School
WC Griggs Elementary School
WD Robbins Elementary School
Whitley Elementary School
Wilmer Elementary School
WP Davidson High School
MAKE SURE TO ADD ALL YOUR STUDENTS!!!
Click here to add ADDITIONAL students
Student First Name 2
Student Last Name 2
Student Race 2
** Please Select **
AMERICAN INDIAN/ALASKAN NATIVE
ASIAN
BLACK/AFRICAN AMERICAN
HISPANIC
Multi
NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER
NOT ASSIGNED
WHITE
Student Gender 2
** Please Select **
Female
Male
Non-Binary
Student Date Of Birth 2
Student Grade Level 2
** Please Select **
01
02
03
04
05
06
07
08
09
10
11
12
K
PK
Student Last School Attended 2
Social Security # or Student #
Student Zone Location Name 2
Add Another Student #3
Student First Name 3
Student Last Name 3
Student Race 3
** Please Select **
AMERICAN INDIAN/ALASKAN NATIVE
ASIAN
BLACK/AFRICAN AMERICAN
HISPANIC
Multi
NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER
NOT ASSIGNED
WHITE
Student Gender 3
** Please Select **
Female
Male
Non-Binary
Student Date Of Birth 3
Student Grade Level 3
** Please Select **
01
02
03
04
05
06
07
08
09
10
11
12
K
PK
Student Last School Attended 3
Social Security # or Student #
Student Zone Location 3
** Please Select **
Allentown Elementary School
Alma Bryant High School
Anna F Booth Elementary School
Augusta Evans School
Baker High School
Ben C Rain High School
Bernice J Causey Middle School
Booker T Washington Middle School
Breitling Elementary School
Burns Middle School
Calcedeaver Elementary School
Calloway Smith Middle School
CF Vigor High School
Chastang-Fournier Middle School
Citronelle High School
CL Scarborough Model Middle School
Clark-Shaw Magnet School
Collins-Rhodes Elementary School
Continuous Learning Center
Cora Castlen Elementary
Dauphin Island Elementary School
Dawes Intermediate School
Denton Magnet School of Technology
Dixon Elementary School
Dr. Robert W. Gilliard Elementary
Dunbar Creative Performing Arts
Eichold-Mertz School of Math and Science
Elizabeth Fonde Elementary School
Elsie Collier Elementary School
ER Dickson Elementary School
Erwin Craighead Elementary School
Evening Educational Options
Florence Howard Elementary School
Forest Hill Elementary School
George Hall Elementary School
Goodwill Easter Seal Center Special Child
Grand Bay Middle School
Grant Elementary School
Hollingers Island Elementary School
Holloway Elementary
Hutchens Elementary School
Indian Springs Elementary School
J E Turner Elementary
John L Leflore Magnet School
John Will Elementary School
Just 4 Development Laboratory
Kate Shepard Elementary School
Katherine H Hankins Middle School
Leinkauf Elementary School
Lillie B Williamson High School
Lott Middle School
Mary B Austin Elementary School
Mary G Montgomery High School
Mary W Burroughs Elementary School
Maryvale Elementary School
Mattie T Blount High School
McDavid-Jones Elementary School
Meadowlake Elementary
Mobile County Training Middle School
Mobile Mental Health Center
Morningside Elementary School
Murphy High School
Nan Gray Davis Elementary School
North Mobile County Middle School
Not Assigned
O'Rourke Elementary School
Old Shell Road Magnet School
Olive J Dodge Elementary School
Orchard Elementary School
Pearl Haskew Elementary
Peter F Alba Middle School
Phillips Preparatory Middle School
Pillans Middle School
Saint Elmo Elementary School
Semmes Elementary School
Semmes Middle School
Spencer-Westlawn Elementary School
SW Alabama Regional School Deaf-Blind
Tanner Williams Elementary School
Taylor White Elementary School
The Pathway
Theodore High School
TL Faulkner School
UCP Of Mobile Inc
W H Council Traditional School
WC Griggs Elementary School
WD Robbins Elementary School
Whitley Elementary School
Wilmer Elementary School
WP Davidson High School
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.
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