Student Enrollment Form (Elementary School Or Middle School)
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3CHEROKEE COUNTY SCHOOL DISTRICT
STUDENT ENROLLMENT FORM
ELEMENTARY SCHOOL / MIDDLE SCHOOL
SCHOOL USE ONLY
HR TCHR
_____________________________
IMM
Yes
No
_____
______
VHD&N
Yes
No
_____
______
School: ____________________________
Medication
_____________________________
Student ID: ______________
RESIDENCY INFO (Tax Map Page Number)
Parcel No. __________________________
SECTION I: STUDENT INFORMATION
_____________________________
___________________________
____________________
Last Name
First Name
Middle Name
Male / Female
____________
____________________
Gender
Grade
Date of Birth
_____________________
___________________
____________________
Social Security Number
Birthplace (State)
Nickname/Called Name
Ethnic Group: Is this student Hispanic/Latino? (Choose only one)
_______ No, not Hispanic/Latino
_________ Yes, Hispanic/Latino
The above question is about ethnicity, not race. No matter what you selected above, please continue to
answer the following by choosing one or more to indicate what you consider your student’s race to be.
What is the student’s race? (Choose one or more)
_____ American Indian or Alaska Native
_____ Asian
_____ Black or African American
_____ Native Hawaiian or Other Pacific Islander
_____ White
Is the birthplace of the enrolling student outside of the United States?
______ Yes
______ No
If yes, date entered U.S. Schools: ____________________________
Home Language Survey
In order to provide your child with the best possible education, we need to determine how well he or she speaks and
understands English. This survey assists school personnel in deciding whether your child may be a candidate for
additional English language support. Final qualification for language support is based on the results of an English
language assessment.
1.
Which language does your child most frequently speak at home? ___________________________
2.
Which language do adults in your home most frequently use when speaking with your child?
___________________________________
3.
Which language(s) does your child currently understand or speak? __________________________
Rev. 01 July 2016
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