Joel E. Barber C-5 Enrollment Form
Email address *
Student's name as it appears on birth certificate: *
Your answer
Date of Birth *
Your answer
Enrollment Date *
Your answer
Grade *
Your answer
Gender *
Your answer
Social Security Number (Optional)
Your answer
Telephone *
Your answer
Race *
Your answer
Does Student Speak a Language Other Than English? *
Is a Language Other Than English Commonly Spoken in the Home? *
If you Answered Yes to the Preceding Question, What is the Language Spoken in the Home?
Your answer
Students Mailing Address: City *
Your answer
County *
Your answer
State *
Your answer
Are the Parents of the Student Divorced *
If Parents are Divorced Does the School Have Documentation? (If the Answer is no Please Provide Documentation).
Who is the Student Currently Residing With? *
Name of Individual Student is Residing With. *
Your answer
Do the Parents or Legal Guardian Live Within the Boundaries of Joel E. Barber C-5 School District? *
Are the Parents, Legal Guardian or Students Currently Homeless? *
Are You Sharing the Housing of Other Persons Due to Loss of Housing, Economic Hardship, or a Similar Reason? *
If the Answer to the Previous Question was Yes Please Explain.
Your answer
Are you Currently Residing at a Motel, Hotel, in a Car, or at a Campsite Because your Home has Been Damaged or due to Economic Reasons? *
Are you Currently Residing in a Shelter? *
Are you Currently Living in a Temporary Housing Arrangement Due to Economic Hardship? *
Information for: *
Name *
Your answer
Place of Employment *
Your answer
Mailing Address *
Your answer
City *
Your answer
County *
Your answer
State *
Your answer
Do you Want Access to the Parent Portal? *
Email Address for Portal *
Your answer
Home Phone Number *
Your answer
Cell Phone Number *
Your answer
Work Phone Number
Your answer
Information for: *
Do you Want Access to the Parent Portal? *
Email Address for Portal *
Your answer
Home Phone Number *
Your answer
Cell Phone Number *
Your answer
Work Phone Number
Your answer
List Each Sibling Living in the Same Household With the Student. INCLUDE: NAME, AGE and GRADE LEVEL OF SIBLING.
Your answer
List Each Sibling Living in the Same Household With the Student. INCLUDE: NAME, AGE and GRADE LEVEL OF SIBLING.
Your answer
List Each Sibling Living in the Same Household With the Student. INCLUDE: NAME, AGE and GRADE LEVEL OF SIBLING.
Your answer
List Each Sibling Living in the Same Household With the Student. INCLUDE: NAME, AGE and GRADE LEVEL OF SIBLING.
Your answer
List Each Sibling Living in the Same Household With the Student. INCLUDE: NAME, AGE and GRADE LEVEL OF SIBLING.
Your answer
Emergency Contacts: (These Names are Also People Other Than Parents or Legal Guardians that May Pick the Student up From School.
Your answer
Name:
Your answer
Relationship to Student
Your answer
Work Phone Number
Your answer
Cell Phone Number
Your answer
Home Phone Number
Your answer
Name
Your answer
Relationship to Student *
Your answer
Work Phone Numbers
Your answer
Cell Phone Number *
Your answer
Home Phone Number
Your answer
Name *
Your answer
Relationship to Student *
Your answer
Work Phone Numbers
Your answer
Cell Phone Number *
Your answer
Home Phone Number
Your answer
Name
Your answer
Relationship to Student *
Your answer
Work Phone Numbers
Your answer
Cell Phone Number
Your answer
Home Phone Number
Your answer
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