New Kindergarten Student Information - Armstrong
In order to gain some important, basic information about your incoming kindergartner prior to registration and screening in August, please complete the following information.
Student Last Name *
Student First Name *
Student Middle Name *
Nickname *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Address *
Home Phone *
Place of Birth (City, State, Country) *
Race (Check ALL that apply) *
Required
Ethnicity - Is this student Hispanic/Latino? *
Student Resides With:
Please complete the followng information for the parents the student resides with. There will be space to complete information for 2 adults here. Information about additional adults/non-custodial family may be entered in another section. If the student only resides with 1 adult, write "n/a" or "none" in each of those blanks.
#1 Name *
#1 Relationship *
#1 Phone *
#1 Employer *
#1 Work Phone *
#1 Email Address *
#2 Name
#2 Relationship
#2 Phone
#2 Employer
#2 Work Phone
#2 Email Address
Non-Custodial Family (If Applicable)
This section is not required, but please enter information about parents/step-parents that the student does not live with.
#1 Name
#1 Relationship
#1 Phone
#1 Employer
#1 Work Phone
#1 Email Address
#2 Name
#2 Relationship
#2 Phone
#2 Employer
#2 Work Phone
#2 Email Address
Emergency Contacts
Please complete the following information. These contacts should be someone other than parents or those listed above.
Emergency Contact #1 Name *
Emergency Contact #1 Relationship *
Emergency Contact #1 Phone (2 numbers if possible; label appropriately) *
Emergency Contact #2 Name *
Emergency Contact #2 Relationship *
Emergency Contact #2 Phone (2 numbers if possible; label appropriately) *
Names of Brothers and Sisters with their Date of Birth *
Most Recent School Attended (Name and Address of School) *
Has this child ever attended a school in District 86? *
My child is currently receiving special education services *
My child has an IEP (Individualized Education Program) *
My child has a current 504 plan *
My child is currently receiving speech related services *
My child receives extra help in the following areas: *
Home Language *
Thank you for completing this information. Please check www.epd86.org as August nears for registration date and time information. Please remember to bring your incoming kindergarten student with you to registration in order for them to be screened.
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