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Student First Name
Student Middle Name
Student Last Name
Student Date of Birth
Student's Federal Race/Ethnicity Code, part 1
Student's Federal Race/Ethnicity Code, part 2
Select all that apply
1 - American Indian or Alaskan Native
2 - Asian
3 - Black or African American
4 - Native Hawaiian or Other Pacific Islander
5 - White
6 - Multi-race
Student's Home Address
What language is primarily spoken in the home?
American Sign Language (ASL)
Other Language (OTH)
Pilipino Tagalog (PI)
Parent/Guardian First and Last Name
Parent/Guardian Phone Number
Parent/Guardian Email Address
Do you have other children currently attending CUSD#205?
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This form was created inside of Community Unit School District #205.
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