Student Information
Legal Name from Birth Certificate
**Legal Name: **First: Middle: **Last:
**Date of Birth: MM/DD/YYYY
**Gender:
Preferred First Name:
**School:
**Previous School:
Enter NONE in all three boxes
if Kindergarten student
School Name:
City:
State:
**Grade Level: Next Year's Grade Level
**Anticipated Start Date:
Current Special Programs IEP 504 ML/ELL Speech Therapy Gifted and Talented
**Mailing Street/PO Box
**Mailing Address City
**Mailing Address State
**Mailing Address Zip Code
**Birth Certificate Required I acknowledge that I must bring an original birth certificate to complete my student's enrollment.
Upload Documents Are there any guardianship/custody documents the school should be aware of? Please upload them here.
Immunization Card
Parent/Guardian Information
**First Name: **Last Name:
**Relationship to Student:
Other Students in Family: Check this box if other siblings in your family are active students at our schools
**Desired User Name: Desired User Name for PowerSchool Login
**Email:
**Phone: 999-999-9999      Alternate Phone: 999-999-9999
**Street:
**City:
**State:
**Zip Code:
**County
**Verification: I verify that the above information is correct
** Required Information