Jr./Sr. High New Student Enrollment

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Full Name (First, Middle, and Last) *

Today Date: *

YYYY

Date of Birth *

YYYY

Race *

White

American Indian or Alaskan

Asian

Black or African American

Native Hawaiian or other Pacific Islander

Other:

Language *

English

Spanish

Other: please list____________________________________

Gender *

Male

Female

Current Grade *

Address *

City and Zip Code
*

County *

Township *

Student's Previous School *

Health Concerns/Other *

Does your student have an Individualized Education Plan (IEP)? *

Yes

Does your student have a 504 plan?
*

Yes

Did your child play sports in the last 12 months at their previous school? *

Yes

Can we share your student's demographic information with military recruiters? *

Yes

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