Northwest Registration Survey for 2020-2021 School Year
Due to the Covid-19 school closure, the registration process for new students will be different from years past. Please complete the following registration survey for any child that you wish to attend Northwest Elementary for the 2020-2021 academic school year. **

Kindergarten Parents: Children must turn 5 years old by September 30, 2020. Submitting this form is just the first step in the registration process. The school will contact you to collect required documents like birth certificates, custody papers, immunization records, etc.

Preschool Parents: STOP!! Please do not complete this survey until you have submitted the REQUIRED NORTHWEST PRESCHOOL APPLICATION (Click here for application: https://forms.gle/y9y9MJBm2Rey1X7i6). Once you have submitted that application and turned in your proof of income, you will be instructed to proceed with filling out this registration survey. Children should turn 4 years old by September 30, 2020 and be potty-trained for the Northwest ECE Preschool Program.

If you would rather not use this form to submit your information, you have other options. Give us a call or email and let us know what method works best for you. We can even mail you a packet to fill out and send back.
1) Email Mrs. Shannon (melyssa.shannon@nwmohawks.org) or Mrs. Sissel (ronda.sissel@nwmohawks.org)
2) Call 740-259-2250, choose option 7 or extension 3300, leave a message, and your call will be promptly returned.
OR
3) Request a call back through the Northwest Elementary School Facebook Page by sending a message or commenting in the registration survey post.


**The information collected through this form will only be sent to those individuals authorized by the district to access confidential information.
I am completing this survey for a child entering _____________ for the 2020-21 Academic School Year *
Child's First Name *
Your answer
Child's Middle Name *
Your answer
Child's Last Name *
Your answer
Child's Preferred Name
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's City and State of Birth *
Your answer
If the child was born outside of the United States, what country was he/she born in and is his/her native language English? If not, list native language.
Your answer
Biological Mother's Maiden Name *
Your answer
Gender of Student *
Your answer
Child's Ethnicity *
Required
School District of Residence *
Street Address of Residence and P.O. Box if applicable *
Your answer
City of Residence *
Your answer
State of Residence *
Your answer
Zip Code *
Your answer
County of Residence *
Telephone number *
Your answer
Additional telephone number *
Your answer
Email Address
Your answer
Legal Parent(s)/Guardian(s) *
Your answer
Relationship of Legal Parent(s)/Guardian(s) to child *
Required
Parent(s)/Guardian(s) are... *
Are there any papers on file in Juvenile Court with regard to this child's custody? (Divorce papers, Powers Of Attorney, temporary or legal custody orders,etc.). If so, briefly describe. *
Your answer
Biological Father's First and Last Name. Also list his address only if different from the child's address. *
Your answer
Biological Mother's First and Last Name. Also list her address only if different from the child's address. *
Your answer
Is the child a dependent of a member of the Active Duty Forces? *
Is the child a dependent of a member of the National Guard? *
Does this child have any siblings currently attending the Northwest School District? If so, please list name and grade. *
Your answer
Has this child ever repeated a grade in school? If yes, which grade? *
Your answer
Does your child have an IEP ? (Individualized Education Program) *
Has your child ever received or been evaluated for special education services? *
If your child is transferring to our school, please list the Name, City and State of the last school attended. If the child is new to Kindergarten or Preschool, just leave blank. *
If you recently moved into the Northwest School District, please list your previous address.
Your answer
List any other adults to whom your child may be released, their relationship to the child and their contact information. *
Your answer
Do you wish for your child to ride a yellow school bus? *
List any characteristics relating to the health and/or personality of your child that may help teachers, nurses, bus drivers and other staff members better understand your child.
Your answer
Name of person submitting this form and relationship to the child. *
Your answer
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