Northview Elementary School 2018 Kindergarten Student Information
Please complete and submit the information below prior to attending Roundup on April 13, 2018
There are two identical meetings for roundup. Which meeting will you attend? *
STUDENT'S Last Name *
Your answer
STUDENT'S First Name *
Your answer
Preferred Name
Example: Michael - Mike
Your answer
Gender *
Student's Date of Birth *
Student must be 5 years old prior to August 1, 2017 to attend kindergarten
MM
/
DD
/
YYYY
Ethnicity *
Check all that apply
Required
Student's House Number *
Example: 305
Your answer
Student's Street Name *
Example: Franklin St - please use abbreviation Ave, Ct, Dr, Ln, Pkwy, Pl, Rd, St, Ter
Your answer
Apartment
Example: 1/A
Your answer
Student's Zip Code *
Student Primary Contact Number *
Enter Primary Number In This Format: 219-531-3000
Your answer
Select Phone Type *
Custodial Parent Last Name, Father's First Name/Mother's First Name *
Example: Smith, John/Jane
Your answer
Custodial Parent Relationship *
Custodial Parent's Email Address *
Type: 'None' if you do not have email
Your answer
Non-Custodial Parent's Email Address
Your answer
Mother's Last Name
Your answer
Mother's First Name
Your answer
Mother's Primary Contact Number *
Enter Primary Number In This Format: 219-531-3000
Your answer
Select Phone Type *
Father's Last Name
Your answer
Father's First Name
Your answer
Father's Primary Contact Number *
Enter Primary Number In This Format: 219-531-3000
Your answer
Select Phone Type *
Is Engish the primary language spoken at home? *
List other language(s) spoken at home
Your answer
Does your child have any special needs, either academically or physically? *
Has your child been evaluated or received services from Porter County Educational Services? *
Please let us know if they attend SELF now or have in the past
Your answer
Describe any special needs information
Your answer
Does your child have siblings at this school? *
Names of siblings at this school
Sibling Name: Last, First
Your answer
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