SCSD ECC New Student Application 2020-21
New Student Application for the 2019 - 2020 School Year.
Student's Last Name *
Student's First Name *
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Check All that Apply *
Date of Birth *
State and Country of Student's Birth *
If Student was not born in the US, when did the student move to the US?
Student's Primary Street Address *
Student's City and Zip Code *
Our Address is in the St. Charles School District Boundaries (Please note: priority is given to district residents.)
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Mother's Name
Mother's Street Address
Mother's City, State, Zip Code
Mother's Home Phone
Mother's Cell Phone
Mother's Email Address
Father's Name
Father's Street Address
Father's City, State, Zip Code
Father's Home Phone
Father's Cell Phone
Father's Email Address
Student Primarily lives with: *
Who has primary custody of the student? *
If 'other' than parent has custody of the student, who has guardianship?
Guardian First Name
Guardian Last Name
Guardian Phone
Has your child had a Special Education Evaluation? *
Was your child in a Special Education Program? *
Are you enrolled in the Parents as Teachers Program? *
If Yes, who was the Parent Educator?
Has your child had a DIAL-4 screening within the last 6 months? *
If yes, date of screening.
First Class Choice *
Second Class Choice *
Before/After Care Needs (Choose One) *
Do you have any other children under the age of 5? If so, please list their Name(s) and Date of Birth and preschool attended/attending (if applicable).
Are you a current St. Charles School District Employee?
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