Ben Franklin Middle School New Student Information 2017-18
Please complete and submit the information below. Based on the information you provide here, you will be contacted for an appointment to enroll your student.
STUDENT'S Last Name
Your answer
All New Students and Parents must meet with a Guidance Counselor to create their schedule
Please select time preference
8:00-10:00 a.m.
10:00 a.m.-12:00 p.m.
12:00-2:00 p.m.
1st Choice
2nd Choice
3rd Choice
STUDENT'S First Name
Your answer
Preferred Name
Example: Michael - Mike
Your answer
Gender
Student's Date of Birth
MM
/
DD
/
YYYY
Student's Birth City:
Your answer
Student's Birth State:
Your answer
Ethnicity
Check all that apply
Required
Student's House Number
Example: 305
Your answer
Student's Street Name
Example: Franklin St - please use abbreviation Ave, Ct, Dr, Ln, Pkwy, Pl, Rd, St, Ter
Your answer
Apartment
Example: 1/A
Your answer
Student's Zip Code
Phone number where you prefer to be contacted for this appointment
Enter Primary Number In This Format: 219-531-3000
Your answer
Select Phone Type
Custodial Parent Last Name, Mother's First Name/Father's First Name
Example: Smith, Jane/John
Your answer
Custodial Parent Relationship
Custodial Parent's Email Address
Type: 'None' if you do not have email
Your answer
Non-Custodial Parent's Email Address
Your answer
Mother's Last Name
Your answer
Mother's First Name
Your answer
Mother's Primary Contact Number
Enter Primary Number In This Format: 219-531-3000
Your answer
Select Phone Type
Father's Last Name
Your answer
Father's First Name
Your answer
Father's Primary Contact Number
Enter Primary Number In This Format: 219-531-3000
Your answer
Select Phone Type
Is Engish the primary language spoken at home?
List other language(s) spoken at home
Your answer
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
Your answer
Describe any special needs information
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Does your child have siblings at this or any other VCS school?
Names and Grade of Siblings
Sibling Name: Last, First and Grade
Your answer
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