Northwest Elementary Online Registration Form for 2021-2022 School Year
Please complete the following registration survey for any child that you wish to attend Northwest Elementary for the 2021-2022 academic school year. **
Kindergarten Parents: Children must turn 5 years old by September 30, 2021. Submitting this form is just the first step in the registration process. You must also provide copies of your child's birth certificate, social security card, immunization records and custody papers (if applicable).
Choose one of these many different ways you can submit your documents required for enrollment:
1) Take a picture of your document and email it directly to
melyssa.shannon@nwmohawks.org
2) Use the Notes app on an iPhone to scan and email documents to
melyssa.shannon@nwmohawks.org
(Learn
how at
https://support.apple.com/en-us/HT210336
3) If you have a Google account, you can upload your income forms at
https://forms.gle/vrfkU9ekrJFqjupq8
4) Bring your documents to the school and we will make a copy to keep for our records.
Preschool Parents: STOP!! Please do not complete this form until you have submitted the REQUIRED NORTHWEST PRESCHOOL APPLICATION (found under the Parents tab on the NLSD web page), been accepted into the program, and have been instructed to fill out this form. Children should turn 4 years old by September 30, 2021 and be potty-trained for the Northwest ECE Preschool Program.
If you would rather not use this form to submit your information, you have other options. Give us a call or email and let us know what method works best for you.
1) Email Mrs. Shannon (
melyssa.shannon@nwmohawks.org
) or Mrs. Sissel (
ronda.sissel@nwmohawks.org
)
2) Call 740-259-2250, choose option 7 or extension 3300, leave a message, and your call will be promptly returned.
**The information collected through this form will only be sent to those individuals authorized by the district to access confidential information.
* Required
I am completing this survey for a child entering _____________ for the 2021-22 Academic School Year
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Preschool
Child's First Name
*
Your answer
Child's Middle Name
*
Your answer
Child's Last Name
*
Your answer
Child's Preferred Name
Your answer
Child's Date of Birth
*
MM
/
DD
/
YYYY
Child's City and State of Birth
*
Your answer
If the child was born outside of the United States, what country was he/she born in and is his/her native language English? If not, list native language.
Your answer
Biological Mother's Maiden Name
*
Your answer
Gender of Student
*
Your answer
Child's Ethnicity
*
White (non-Hispanic)
Black
Asian
American Indian
Hispanic
Multiracial
Other:
Required
School District of Residence
*
Northwest Local School District
Other:
Street Address of Residence and P.O. Box if applicable
*
Your answer
City of Residence
*
Your answer
State of Residence
*
Your answer
Zip Code
*
Your answer
County of Residence
*
Scioto County
Other:
Telephone number
*
Your answer
Additional telephone number
*
Your answer
Email Address
Your answer
Legal Parent(s)/Guardian(s)
*
Your answer
Relationship of Legal Parent(s)/Guardian(s) to child
*
Biological Parent(s)
Grandparent(s)
Foster Parent (child in custody of Children Services)
Temporary Custodian through Juvenile Court Order
Legal Custodian through Juvenile Court Order
Other:
Required
Parent(s)/Guardian(s) are...
*
Married
Never Married
Living Together
Seperated
Divorced
Widowed
Other:
Are there any papers on file in Juvenile Court with regard to this child's custody? (Divorce papers, Powers Of Attorney, temporary or legal custody orders,etc.). If so, briefly describe.
*
Your answer
Biological Father's First and Last Name. Also list his address only if different from the child's address.
*
Your answer
Biological Mother's First and Last Name. Also list her address only if different from the child's address.
*
Your answer
Is the child a dependent of a member of the Active Duty Forces?
*
Choose
Yes
No
Is the child a dependent of a member of the National Guard?
*
Choose
Yes
No
Does this child have any siblings currently attending the Northwest School District? If so, please list name and grade.
*
Your answer
Has this child ever repeated a grade in school? If yes, which grade?
*
Your answer
Does your child have an IEP ? (Individualized Education Program)
*
Choose
Yes
No
Unsure
Has your child ever received or been evaluated for special education services?
*
Choose
Yes
No
Unsure
If your child is transferring to our school, please list the Name, City and State of the last school attended. If the child is new to Kindergarten or Preschool, just leave blank.
*
Your answer
If you recently moved into the Northwest School District, please list your previous address.
Your answer
List any other adults to whom your child may be released, their relationship to the child and their contact information.
*
Your answer
Do you wish for your child to ride a yellow school bus?
*
Choose
Yes
No
Maybe
List any characteristics relating to the health and/or personality of your child that may help teachers, nurses, bus drivers and other staff members better understand your child.
Your answer
Name of person submitting this form and relationship to the child.
*
Your answer
Submit
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