Student Information
Holmes District Schools
School Enrolling In *
Student Last Name *
Your answer
Student First Name *
Your answer
Student Middle Name *
Your answer
Date of Birth *
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Sex *
Grade level enrolling in *
Physical Street Address (No P.O. Boxes) *
Your answer
City *
Your answer
State *
Zip Code *
Your answer
Mailing Address (if different)
Your answer
City
Your answer
State
Primary Phone Number (including area code) *
Your answer
Secondary Phone Number (including area code) *
Your answer
Number to be Used for Automated Calls #1 *
Your answer
Number to be Used for Automated Calls #2
Your answer
Social Security Number
Your answer
Ethnicity--Hispanic/Latino *
Race (Check all that apply) *
Required
Does student reside in Holmes County? *
Has student ever attended any Florida schools? *
If yes, what county?
Your answer
Has student previously attended other Holmes County Schools? *
If yes, what school?
Your answer
Name of Last School Attended
Your answer
Is student a member of a military family? (Mother or father on active duty, deceased while on active duty, or disabled veteran? *
Place of Birth--City *
Your answer
Place of Birth--County *
Your answer
Place of Birth--State *
Your answer
Place of Birth--Country *
Required
Citizenship of Residency
If not a U.S. Citizen, date entered U.S.
MM
/
DD
/
YYYY
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