K-12th Admission Forms Admission Forms Step 1Step 2Step 3Step 4Step 50% Complete1 of 5 Enrollment Application Form Student ID Number Enrollment Date Grade Entering * Scholarship * Student's Legal Name * Student's Legal Name First First Last Last Date of Birth * Age * Social Security Number * Place of Birth Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Phone Number * Email * Gender * Plase Select An OptionMaleFemale Ethnic Plase Select An OptionNon-HispanicHispanic Race Plase Select An OptionWhiteAsianAmerican Indian / Alaska NativeBlack or African AmericanNative Hawaiian or Other Pacific Islander Student Lives With * Plase Select An OptionBoth ParentsMother OnlyLegal GuardianFather Only Who has legal responsibility for school decisions ? * Other Children's Living at Home ? * Plase Select An OptionYesNo How Many Children? * Plase Select An Option123 Child 1 Child's Name * Child's Name First First Last Last Relation to Student * School Grade Child 2 Child's Name * Child's Name First First Last Last Relation to Student * School Grade Child 3 Child's Name * Child's Name First First Last Last Relation to Student * School Grade Special Service Testing ? * Plase Select An OptionYesNo Checkboxes * Speech Attention-deficit/hyperactivity disorder Learning Disabilities Emotional Impairment Does the student most frequently speak a language other than English? * Plase Select An OptionYesNo What Languages? * Did the student have a first language other than English? * Plase Select An OptionYesNo What Language? * Is a language other than English spoken at home? * Plase Select An OptionYesNo What Language? * Has the student ever been dismissed from a previous school? * Plase Select An OptionYesNo Please Explain * Has the student ever experienced academic, behavior, emotional, or attention difficulties that resulted in discussion or evaluation by a school official, psychologist, or other professionals? * Plase Select An OptionYesNo Please Give Details * Has the student been identified as a special education student or has an active Individualized Education Program? * Plase Select An OptionYesNo Does the student have a current 504? * Plase Select An OptionYesNo Is the student a participant of the Gardiner or McKay scholarship? * Plase Select An OptionYesNo Which One? Did the student study in another school? * Plase Select An OptionYesNo Last three schools attended (Begin with the most recent- For Kindergarten, please list PRE-K, VPK, Head Start) if applicable Plase Select An Option123 School 1 Type of School * Plase Select An OptionPublicHomePrivate Education Name of the School * City, State * Years Attended * Grade * School 2 Type of School * Plase Select An OptionPublicHomePrivate Education Name of the School * City, State * Years Attended * Grade * School 3 Type of School * Plase Select An OptionPublicHomePrivate Education Name of the School * City, State * Years Attended * Grade * Signature * signature keyboard Clear Date * Relationship to Student * If you are human, leave this field blank. Next
