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Student Enrollment Form
Student Enrollment Form
Last Name
Your answer
First Name
Your answer
Middle Name
Your answer
DOB
MM
/
DD
/
YYYY
Gender
Your answer
Student Race
Is the student Hispanic or Latino?
Phone Number
Your answer
Grade Level
School Preference - 1st Choice for grades K-5
School Preference - 2nd Choice for grades K-5
School Preference - 3rd Choice for grades K-5
School Preference - 4th Choice for grades K-5
Date first entered School
Your answer
Date first entered KS school
Your answer
Has your family moved in the last 36 months to seek or obtain agriculture or fishing related work?
If yes, was the move from one school district to another?
Mother's Name
Your answer
Mother's Cell
Your answer
Father's Name
Your answer
Father's Cell
Your answer
Guardian's Name
Your answer
Guardian's Cell
Your answer
Student's Home Street Address
Your answer
City
Your answer
State
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Zipcode
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Email address you wish to be contacted at
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Previous school student was enrolled at
Your answer
Previous school address
Your answer
Previous school phone number
Your answer
Does your student currently have an IEP or other educational plan?
Is your student under any form of suspension?
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