Student Information
Student Last Name *
Student First and Middle Name *
Date of enrollment *
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Gender *
Hispanic/Latino Ethnicity: *
RACE *
Date of birth *
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City and state of birth. *
Child lives with (select all that apply) *
Required
Grade *
Transportation
Primary language spoken by child. *
Primary language spoken in home. *
Is the applicant currently expelled? *
Is the student a party to an expulsion proceeding? *
Has the student ever been in any special education classes? *
Has the student ever received speech therapy? *
List any special services your child has ever received or physical challenges they may currently have.
Name of last school attended. *
Address of last school attended.
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