Student Enrollment Form
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2STUDENT ENROLLMENT FORM
UNION COUNTY PUBLIC SCHOOLS
For Office Use Only:
Student ID ______________________________
Enrollment Date______________ Grade____
Registration completed ___________________
School ________________________________
Need
Immunization Record
Birth Certificate
POR
Transportation _________________________
School Receiving Packet _________________________
Teacher’s Name ________________________
Date Received ____________________
Packet received by______________________
Please indicate the student’s academic placement:
New Kindergartener for the _______________ school year
New Pre-Kindergartener for the _____________ school year
New student entering grade ______ for the _______________ school year
Student Information
Birth certificate or other satisfactory evidence of age and official record of immunizations must be presented at time of enrollment.
Copies of these documents are to be placed in folder and originals returned to parent/guardian.
Legal Name _________________________________________________________________ / ____________________
Last
First
Middle
Nickname
Physical address ___________________________________________________________________________________
House/Apt. Number
Street
City
State
Zip
Mailing Address
____________________________________________________________________________
(if different)
House/Apt. Number
Street
City
State
Zip
Home Phone ________________________
Male
Female
Date of Birth __________________ Place of Birth________________________________
Month/Day/Year
City/State/Country
Ethnicity:
Hispanic
Non-Hispanic
Race:
American Indian
Black
Asian
Hawaiian/Pacific Islander
White
(select all that apply)
Child resides with ______________________________________________ ___________________________________
Relationship to Student
Legal Custodian_________________________________________ Legal paperwork provided to school
Yes
No
Family Information
Father’s Full Name _________________________________________________________________________________
Place of Birth
___________________________________________________ Deceased
Yes
No
City/State/Country)
(
Address __________________________________________________________________________________________
Home Phone _________________________
Cell Phone _____________________________
Employer _____________________________________________ Work Phone ____________________________
Highest Education level completed _____________ E-mail address __________________________________________
Mother’s Full Name (
_________________________________________________________________
include maiden name)
Place of Birth
___________________________________________________ Deceased
Yes
No
City/State/Country)
(
Address __________________________________________________________________________________________
Home Phone _________________________
Cell Phone ______________________________
Employer _____________________________________________ Work Phone ____________________________
Highest Education level completed _____________ E-mail address __________________________________________
Stepparent’s, Legal Guardian’s, or Sponsor’s
Relationship to student_____________________
information (
)
if applicable
Name _______________________________Address______________________________________________________
Home/Cell Phone ____________________Employer _____________________ Business Phone___________________
E-mail address _____________________________________________________________________________________
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