Student Information
Student's Last Name *
Your answer
Student's First Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade Level (2017-2018 School Year) *
Gender *
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Current School
Primary Ethnicity (Optional)
What language did your child first learn to speak?
What language does your child use the most at home?
What is the primary language used in the home, regardless of the language spoken by your child?
Does the child currently receive free or reduced lunch?
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