Enrollment Form

Student's Legal Name *REQUIRED*

Grade in Fall 2012

Birth Date

Home Address

City *REQUIRED*

State *REQUIRED*

Zip Code *REQUIRED*

Age on Sept 1, 2011

Last School Attended

District of Residence

With Whom is the Student Currently Living?

Does student have a sibling enrolled in this school?

If yes, what is their name?

Parent/Legal Guardian Name *REQUIRED*

Relationship to Student

Address (if different from above)

City

State

Zip Code

Phone

E-mail Address

Language Preference/Idioma Principal

Questions & Comments

Preferred Response