EAK Interest Form 2019/2020
Student Legal First Name *
Your answer
Student Legal Last Name *
Your answer
Student Date of Birth - must turn 5 yrs old between Dec 3 , 2019 and February 28, 2020 *
example: 12/3/2012
Your answer
Street Address *
Physical address where student lives - full address including apartment or space number
Your answer
City/State/Zip Code *
Your answer
Parent Name (First/Last) *
Your answer
Parent Contact Phone Number *
Include Area Code
Your answer
Parent Email Address *
All registration will be completed via online parent portal; a valid email address is required.
Your answer
EAK Program: *
Do you have other students enrolled in the Lakeside district?
Has your student ever received Special Ed services? *
If yes, please choose which services they received.
Does your student have any medical conditions we should be aware of? *
If Yes for medical, what are the concerns:
Your answer
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