Adrian Elementary Registration Form
Please fill out the Registration form for enrollment consideration into Adrian Elementary School
Email address *
Student Name (Last, First, Middle) *
Student Birthdate *
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DD
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Student Age *
Student Grade *
Student Gender *
Birthplace (City, County, State) *
Student Social Security Number Request Information
Adrian Public School District #511 is required to participate in the State of Minnesota computer reporting system. This system will provide data on each student to calculate our portion of state education dollars. Data from the system will be totaled to also provide counts of students for State and Federal reporting requirements. The new system will use social security numbers as a means of recording student data. We request you acknowledge this question whether or not you provide the social security number so that we can meet state information needs. In accordance with the Federal Data Privacy Act of 1974 and the Minnesota Privacy Law (M.S. Section 13.43), you do not have to provide the social security number. If you do not wish to provide the social security number, our district will assign a unique number for the student.
Student Social Security Number
Previously Attended A MN School *
Required
If yes, what district and year attended.
Special Education/IEP *
School(s) previously attended (please include school name, city and state): *
Father's Name (Last, First)
Father's Mailing/Physical Address
Father's Cell Phone Number
Father's Work Place & Phone Number
Father's Email Address
Mother's Name (Last, First)
Mother's Mailing/Physical Address
Mother's Cell Phone Number
Mother's Work Place & Phone Number
Mother's Email Address
Guardian's Name (Last, First)
Guardian's Mailing/Physical Address
Guardian's Cell Phone Number
Guardian's Work Place & Phone Number
Guardian's Email Address
Please list Brothers and/or Sisters
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