Central Elementary School New Student Information 2020-21
Please complete and submit the information below to enroll your child
STUDENT'S Last Name *
STUDENT'S First Name *
Preferred Name
Example: Michael - Mike
Gender *
Student's Date of Birth *
Student must be 5 years old prior to August 1, 2017 to attend kindergarten
MM
/
DD
/
YYYY
Student's Birth City *
Student's Birth State: *
Ethnicity *
Check all that apply
Required
Student's House Number *
Example: 305
Student's Street Name *
Example: Franklin St - please use abbreviation Ave, Ct, Dr, Ln, Pkwy, Pl, Rd, St, Ter
Apartment
Example: 1/A
Student's Zip Code *
Student Primary Contact Number *
Enter Primary Number In This Format: 219-531-3000
Select Phone Type *
Custodial Parent Last Name, Mother's First Name/Father's First Name *
Example: Smith, Jane/John
Custodial Parent Relationship *
Custodial Parent's Email Address *
Type: 'None' if you do not have email
Non-Custodial Parent's Email Address
Mother's Last Name
Mother's First Name
Mother's Primary Contact Number *
Enter Primary Number In This Format: 219-531-3000
Select Phone Type *
Father's Last Name
Father's First Name
Father's Primary Contact Number *
Enter Primary Number In This Format: 219-531-3000
Select Phone Type *
Is Engish the primary language spoken at home? *
List other language(s) spoken at home
Does your child have any special needs *
Has your child been evaluated or received services from Porter County Educational Services? *
Please let us know if they attend SELF now or have in the past
Describe any special needs information
Does your child have siblings at this or any other VCS school? *
Names and Grade of Siblings
Sibling Name: Last, First & Grade
Submit
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