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Education
Admissions Form
Admissions Form
Please Fill Out The Admissions Form Below
Child's Legal First Name
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Child's Middle Name
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Child's Legal Last Name
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Child's Preferred Name
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Home Street Address
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Apt. #
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City
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Zip Code
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Gender
Female
Male
Date of Birth:
Calendar
Grade Entering
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Special Education:
No
Yes
504 Plan:
No
Yes
U.S. Citizen:
No
Yes
ESL:
No
Yes
If Yes, what is the Native Language:
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Ethnic Group:
Caucasian
African American
Hispanic
Asian
Native American
Multi-Racial
Prefer Not To Answer
Other
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Last School Attended:
Date Last Attended:
Calendar
Last Grade Completed:
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Student resides with:
Both Parents
Mother
Father
Other
Other
If Other, Name and Relationship:
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Legal/Custody Papers?
No
Yes
Mother's First Name
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Mother's Last Name
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Mother's Home Phone Number
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Mother's Street Address
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Mother's City of Residence
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Mother's Cell Phone
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Mother's Place of Employment
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Mother's Work Phone
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Father's First Name
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Father's Last Name
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Father's Home Phone Number
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Father's Street Address
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Father's City of Residence
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Father's Cell Phone
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Father's Place of Employment
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Father's Work Phone
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Guardian's First Name
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Guardian's Last Name
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Guardian's Home Phone Number
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Guardian's Street Address
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Guardian's City of Residence
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Guardian's Cell Phone
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Guardian's Place of Employment
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Guardian's Work Phone
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Emergency Contact (First Name):
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Emergency Contact (Last Name):
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Emergency Contact (Phone Number):
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Relationship to Child:
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Emergency Contact (First Name):
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Emergency Contact (Last Name):
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Emergency Contact (Phone Number):
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Relationship to Child:
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