Levittown Public Schools: New Student Intake Form 2021-22
Please fill out the fields below for registration of students in Levittown Public Schools. Please fill out one Intake Form for each child.
Email *
Student First Name *
Student Last Name *
Grade *
Student's Birthdate *
MM
/
DD
/
YYYY
Gender *
Would you prefer the Registration packet sent via email or mailed to current address? *
Parent/ Guardian 1's Name (Last, First) *
Parent/ Guardian 1's Cell *
Parent/ Guardian 1's email address
Parent/ Guardian 2's Name (Last, First) *
Parent/ Guardian 2's Cell *
Parent/ Guardian 2's email address
Current Address (Street) *
Current Town *
Current Zip Code *
Current School Name *
Current School Address *
Current School Phone Number *
Current School Fax Number *
Moving To: NEW ADDRESS Street *
Moving To: NEW ADDRESS Town
Moving To: NEW ADDRESS Zip Code
New residence? *
Received ENL Services *
Receives Special Education Services *
Child has an IEP *
Child has a 504 *
Submit
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