MTM Enrollment Form English
Please fill out the form and click the send button. You will be required to fill out a paper Enrollment Form once school reopens. Thank you.
Email address *
Office Only 1: Student ID: Please do not fill out.
Office Only 2: Student State ID (SSID): Please do not fill out.
3. Last Name, First, Middle, Suffix *
4. First Name on teacher rosters: *
5. Former legal name(s) (optional):
6. Birthdate: mm/dd/yyyy *
7. Gender *
8. Is student Hispanic or Latino/a/x *
9. Race: Check all boxes that apply *
Required
10. Release of Information: Directory-type information may be shared with individuals and organizations authorized to receive this type of information unless it is prohibited by the parent/guardian. See the district's Facts for Parents for the individuals and organizations, and the student information that may be released. If you do not want the information shared, you MUST select "Opt Out." *
Required
11a. Student email address (optional):
11b. Student phone number (optional):
12. Household Address, City, State, Zip Code: *
13. Primary phone: *
14. Mailing address (if different from household) City, State, Zip Code: *
15. City, State, Country of birth: *
16. First enrolled in US Preschool mm/dd/yyyy: *
17a. First enrolled in a CA school (TK-12) mm/dd/yyyy): *
17b. First enrolled in a US school (TK-12) mm/dd/yyyy): *
18. Current Caregiver (check one): *
19a. Foster Living Situation: Check one if applicable: *
Required
19b. Temporary/inadequate residence due to financial hardship: Check all that apply *
Required
20. Other Living Situation: *
Required
21. Complete and include all minors under 18 years of age who live in the same household (siblings and non-siblings), even if not enrolled in San Diego Unified. Include: Full Name: Birthdate: School Name: Relationship to student: *
22. Contact Information. Parent/Guardian Contact: Full Name *
22a. Relationship to student: *
22b. Lives with student? *
22c. Provide Address, City, State, Zip Code here.
22d. Home phone:
22e. Work phone:
22f. Cell phone:
22g. Email address:
22h. Employer:
22i. Military (check all that apply): *
Required
22j. Primary Language *
22k. Education Level (Select one) *
22l. Additional information: Report card and progress report provided. Select all that apply:
23. Contact Information. Parent/Guardian Contact: Full Name *
23a. Relationship to student: *
23b. Lives with student? *
23c. Parent/Guardian/Contact address if not living with student. Address, City, State, Zip Code *
23d. Home phone:
23e. Work phone:
23f. Cell phone:
23g. Email address:
23h. Employer:
23i. Military (check all that apply):
23j. Primary Language *
23k. Education Level (Select one) *
23l. Additional information: Select all that apply:
24. Emergency Contact (other than already listed) Full name:
24a. Relationship to student: *
24b. Home phone:
24c. Work phone:
24d. Cell phone:
24e. Email address:
24f. Primary Language *
24g. Interpreter required
Clear selection
24h. OK to release student *
25. Emergency Contact (other than already listed) Full name:
25a. Relationship to student: *
25b. Home phone:
25c. Work phone:
25d. Cell phone:
25e. Email address:
25f. Primary Language *
25g. Interpreter required
Clear selection
25h. OK to release student *
QUESTION FOR PARENT/GUARDIAN. The following questions provide important information for the school staff. Parents must review the following questions. Check "Yes" or "No" for each question where appropriate. Questions 29 require that you check "Opt Out" or "Opt In".
26a. Has your student ever received SPECIAL EDUCATION services? *
26b. Does your student have a 504 PLAN? *
27. Has one of the parents/guardians engaged in migrant work (moved and worked seasonally in jobs related to agriculture, lumber or fishery) in the past three years? *
28. Name, city, and state/country of last school attended and last grade completed? *
29. (For students in Grades 7, 9, &11) The district would like your student to participate in the California Healthy Kids Survey (CHKS). If you do not want your student to participate, you must select "Opt Out". *
30. (High school students only) Has your student ever played interscholastic athletics?
Clear selection
31. (Grade 12 only) The district is required to submit Cal Grant high school GPA to the California Student Aid Commission (CSAC) for all graduating seniors unless the parent opts out of the submission process. The GPA will be submitted electronically by October 1 of each year unless your select "Opt Out", or submit an Opt Out form. https://wwwmygrantinfo.csac.ca.gov/
Clear selection
32. (High School only) Federal law requires release of student information to military recruiters. If you do NOT want this information released for your student, you must select "Opt Out". http://www2.ed.gov/policy.gen/guid/fpco/hottopics/ht-10-09-02a.html
Clear selection
33a. (High school only) Parents may authorize their student's school to release educational information including: Transcripts, letter of recommendation, financial aid forms, report cards, and class ranking status including UC ELC data. By checking "Yes" I give permission to State/Federal Financial Aid Programs/Scholarship Programs/Private Schools/University/College personnel and their authorized agents to access my student's educational records. Special education and medical information will not be released without additional consent (a separate form will need to be submitted).
Clear selection
33b. (High school only) Parents may authorize their student's school to release educational information including: Disciplinary Records. By checking "Yes" I give permission to State/Federal Financial Aid Programs/Scholarship Programs/Private Schools/University/College personnel and their authorized agents to access my student's educational records. Special education and medical information will not be released without additional consent (a separate form will need to be submitted).
Clear selection
34. LEA Medi-Cal Billing Program (Facts for Parents: Sedtion F-Notice Regarding the District's participation in the LEA Medi-Cal Billing Program) *
The information provided on this form is true to the best of my knowledge. Type in parent signature and date. *
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