Walled Lake Consolidated Schools Official Student Information

Document Sample
Walled Lake Consolidated Schools Official Student Information Powered By Docstoc
					4/09

                                                  PRESCHOOL – Official Student Information Record
                                                                                                                                                                         Child’s Last Name




Program: Tuition Based  Head Start                                    GSRP                               Today’s date __________ Start date __________ School Year ________

Home Elementary _____________________ Is child currently enrolled in a Walled Lake Consolidated Schools Special Services Program? Yes  No 

STUDENT INFORMATION                                      PLEASE PRINT-LEAVE BLANK SPACE BETWEEN LAST, FIRST, and MIDDLE NAME

                                                                                                                                                           Male    □          Female   □
        Legal Last Name (include Jr, II, etc)                   Legal First Name                                             Full Middle Name
                                                                                                                                                         City of Birth _____________________

   House Number                          Street                                                     Apt Box or Lot #                Date of Birth        State ______________________

                                                                                                                                                         County __________ Country ______
             City                                                                 Zip Code                 Home Phone with Area code

Mother ______________________ Cell Phone _______________________ Work Phone ____________________ email ______________________________

Father ______________________ Cell Phone _______________________ Work Phone ____________________ email ______________________________
If you live outside the boundaries of the Walled Lake Consolidated School District, what school district do you live in?______________________________

LANGUAGE IN THE HOME
Is child’s first language different than English? Yes                       No          Is a language other than English spoken in your home? Yes  No 
Languages spoken in home______________________ What is child’s strongest language? ___________________Date child arrived in USA? ______
Registrar: If answer to either one of the first 2 questions is Yes, you must send a copy of this form along with our Home Survey Questionnaire to the Bilingual/ESL office.
ETHNICITY/RACE
Is child Hispanic/Latino? NO, not Hispanic/Latino                            YES, Hispanic/Latino                    (No matter what your answer, please continue to answer the following)
What is child’s race? (check ALL that apply)                       American Indian or Alaska Native                         Asian or Asian American 
Black or African American                        White            Hispanic or Latino                  Native Hawaiian or Other Pacific Islander 

Office Use Only: Admit  Discharge  Reason _________________
Session # ______ AM  PM                         3yr  4yr  Drop Date _________                     Parent/Guardian Signature _______________________________

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:3
posted:9/29/2012
language:Unknown
pages:1