Valparaiso High School New Student Information 2018-19
Please make certain you live within the Valparaiso Community School district prior to registering for classes. You may verify this with either the VHS main office at 219-531-3070 or the Administration Office at 219-531-3000.

Please complete and submit the following information. Based on the information you provide you will be contacted by the Guidance Department personnel to make an appointment for enrollment and scheduling of classes. Appointments will take place beginning August 1st through August 11th.

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 *
MM
/
DD
/
YYYY
Student's Birth City: *
Your answer
Student's Birth State: *
Your answer
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 *
Phone number where you prefer to be contacted for this appointment. *
Enter Primary Number In This Format: 219-531-3000
Your answer
Select Phone Type *
Custodial Parent Last Name, Mother's First Name/Father's First Name *
Example: Smith, Jane/John
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 *
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 or any other VCS school? *
Names and Grade of Siblings
Sibling Name: Last, First and Grade
Your answer
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