New Student Registration
Please complete the information to the best of your ability.  If you are unsure, please write your question(s) in the last section at the end of the form.

If you have more than one student attending, please complete one form for each student.
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Email *
Student Information
Student Name (First, Middle, Last) *
Preferred Name (if applicable)
Which grade will the student be entering? *
Will the student be riding the bus? *
Is this student the youngest family member enrolled (or to be enrolled) in this school? *
Student Home Phone *
Student Gender *
Student Date of Birth *
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Student Ethnicity *
Student Physical Address *
Student Mailing Address *
Parent Information
Mother's Name (First, Last) *
Mother's Home Phone  *
Mother's Cell Phone *
Mother's Employer/Work or Day Phone
Mother's Preferred Daytime Contact Method
Clear selection
Mother's Address (if different)
Father's Name  (First, Last) *
Father's Home Phone  *
Father's Cell Phone *
Father's Employer/Work or Day Phone *
Father's Preferred Daytime Contact Method
Clear selection
Father's Address (if different)
Parent/Guardian Email Address *
Living Arrangements
Is the household a single parent household? *
With whom does the student currently reside? *
If the student currently has a Step-Parent, Guardian, Foster Parent, Custodian, Group Home, etc., please indicate the name, relationship, and contact information for any applicable individuals.
Emergency Contact Information - Local Individual that is Not a Parent
What is the name of the first emergency contact and relationship to the student?  Please include first and last name. *
What is the phone number of the first emergency contact?   *
What is the name of the second emergency contact and relationship to the student?  Please include first and last name.
What is the phone number of the second emergency contact?
What is the name of the third emergency contact and relationship to the student?  Please include first and last name.
What is the phone number of the third emergency contact?
Medical Information
What is the name of the child's doctor, location of the doctor, and phone number for the doctor? *
What is the name of the child's dentist and phone number for the dentist?
Does the student have any allergies?  Please list all allergies and any medications (if applicable). *
What is the severity of the allergic reaction?
Will the student require an Epi-Pen for school? *
If the student requires an Epi-Pen, when will school personnel need to administer the Epi-Pen in the instance it is needed?
Does the student use an Inhaler?
 *
If the student has any health concerns, please list them here. *
Please list any medications the student may need to take during the school day. *
Please Note:  If the student will take any medications at school, including over-the-counter pain relievers, the student's parent must complete the Medication Authorization Form and return it to the office.  This form must be completed each year.  Most medications will be stored and administered in the office.  These medications must be given to the office when the form is turned in, and will be returned at the end of the school year.  Office personnel will notify parents when medication is running low, as necessary.  This form can be picked up from the office or can be found on the school website under the forms tab.
Have any health concerns resulted in a prior emergency medical situation?  Please describe. *
Additional Information - To Be Completed by the Student's Legal Decision Maker
In case of a medical emergency, and I cannot be reached, I give my child's doctor or any attending physician permission to administer medical treatment. *
Please write any other questions or comments you may have regarding this portion of the form here.
I grant permission for my child to participate in school field and study trips under the guidance and direction of employees and/or volunteers from the Glen Ullin Public School.  As parent and/or legal guardian, I remain legally responsible for any personal actions taken by my student.
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Student-Parent Handbook agreements can be accessed online at https://www.glen-ullin.k12.nd.us/ under District Info at any time.  Physical copies may be obtained in the school office.  The Student-Parent Handbook contains essential information about the Glen Ullin Public School.  It is required that every parent/guardian and student read and discuss it.  Parents/guardians are encouraged to read the handbook to younger students.  

Please indicate below that you have read, discussed carefully, and agree to be governed by the philosophy and rules of the Glen Ullin Public School.  Selecting yes below acts as a signature for both the student and the parents/guardians.
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Glen Ullin Public School may photograph your child in the school and at school events/activities.  These photos may appear in our school, on our school webpage, and on our social media, such as Facebook or Twitter.  If you wish to opt out of your student's photograph being shared, please indicate so below.
 *

At Glen Ullin Public School District, we use Google Workspace for Education, and we are seeking your permission to provide and manage a Google Workspace for Education account for your child. Google Workspace for Education is a set of education productivity tools from Google including Gmail, Calendar, Docs, Classroom, and more used by tens of millions of students and teachers around the world. Our students will use their Google Workspace for Education accounts to complete assignments, communicate with their teachers, sign into their Chromebooks, and learn 21st-century digital citizenship skills. 

The Google Consent Form Information link found under District Info on our website provides answers to common questions about what Google can and can’t do with your child’s personal information.

Please read it carefully, let us know of any questions, and then indicate that you’ve read the notice and give your consent. If you don’t provide your consent, we will not create/maintain a Google Workspace for Education account for your child.  This may cause a disruption in educational services for your child. 

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Housing Questionnaire
Date of Form Completion *
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Where is the student currently living? (Please select one) *
In you checked "other temporary living situation," please describe.
If you have any questions or comments regarding the Housing Questionnaire, please describe them here.
Home Language Survey
The U.S. Office of Civil Rights requires schools to identify possible English Learners (EL) students during enrollment to ensure appropriate high quality instruction.  The district may be eligible for additional funding for English learners and/or immigrant children and youth. If a language other than English is used by you or your child and your child meets the English Learner (EL) definition, the school may give your child an English Language Proficiency Assessment.  The school will share the results of the assessment with you.  
What language(s) did your child learn when he/she first began to talk? *
What language(s) does your child speak/use? *
What language does your child use most often? *
Has your child ever been in an English Learner or Bilingual Program? *
Please check any applicable grades for which your child attended school within the United States. *
Required
Please check any applicable grades for which your child attended school outside of the United States. *
Required
If your child has attended school outside of the United States, in which country (or countries) did your child attend school? *
What language(s) did your child learn in school?
If practicable, in what language or format should the school communicate with your family?
Immigrant Student Questions
Would your child be considered an immigrant student?  An immigrant student is any student born outside of the United State which has attended school in the United States for three (3) years or less.
Clear selection
If yes, please list the Country of Origin.  For refugee students, this is the country you originally fled, not the country you lived in most recently.
If yes, please select the date of entry into the United States.
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If yes, please list the Heritage language.
Native American or Alaskan Native Student Questions
Would your child be considered a Native American or an Alaskan Native student?  Native American and Alaskan Native students are mentioned specifically in the EL definition and may qualify for EL services.
Clear selection
Do you believe a tribal language has significantly influenced your child's education in English?
Clear selection
If yes, what is the tribal language?
Migrant Student Questions
Would your child be considered a migrant student?  A migrant student has moved in the past 36 months with or to join a parent/guardian who is a migratory agricultural worker.
Clear selection
If yes, what is the date the child moved this year?
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Refugee Student:
This information is not a state requirement but may be collected at the discretion of the district.
Would your child be considered a newly arrived refugee student?  Schools in North Dakota apply for a Refugee School Impact Grant to provide services for newly arrived refugee students. A refugee student left their home country due to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership in a particular social group, or political opinion and has fled to another country to be resettled. Newly arrived is defined as within the last three years.
Clear selection
Please write any other questions or comments you may have regarding the Home Language Survey here.
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