USD#382 Student Enrollment Form
June 01, 2008
| Pratt High School Liberty Middle
School Haskins Elementary Southwest Elementary Walden Center |
OFFICE USE ONLY
Date
Student Entered |
|
|---|---|---|
Student Information
Last Name (please use legal name):
First Name:
Middle Initial:
Grade:
Social Security Number:
Street Address:
City:
State:
Zip Code:
Mailing Address (if different):
Phone Number:
Date of Birth:
Birth Place:
Male Female
School Attended Last Year:
What language did your child first learn to speak/use?
English Spanish Other (please specify) ______________
What language does your child most often speak/use at home?
English Spanish Other (please specify) ______________
What language do you most often speak/use with your child?
English Spanish Other (please specify) ______________
What language do the adults at home most often speak/use?
English Spanish Other (please specify) ______________
Ethnicity (Optional):
Has student been enrolled in special education classes?
Yes No
If yes, explain:
Is
student under suspension from any other school?
Yes No
Parent/Guardian Information
Student lives with (check all that apply):
Both
Parents Mom
& Stepfather Dad & Stepmother Mom Dad
Other:
[1]Parent/Guardian Name (last name first):
Address:
Home Phone:
Email Address:
Employer:
Employer Phone Number:
[2]Parent/Guardian Name (last name first):
Address:
Home Phone:
Email Address:
Employer:
Employer Phone Number:
Name/Relationship[1]:
Address:
Phone Number:
Email Address:
Name/Relationship[2]:
Address:
Phone Number:
Email Address:
Does student live in USD 382 district? Yes No
If no, what district:
Do you reside 2.5 miles or more from this school? Yes No
Date:
Parent/Guardian Signature (print and sign):
___________________________________________
