Student Enrollment Information Form printable pdf download

Student Enrollment Information Form

2017-2018

Student Name: ____________________________________________________ Gender

Last, First and Middle

Address: ______________________________________City: ______________________Zip: _____________

Phone: ___________________Date of Birth: __________________Place of Birth: _______________________

Religion: __________________ Parish: _____________________Place and date of Baptism______________

School District________________________________ Primary Home Language:

_____________________

Ethnic Background:

African-American (B) American Indian (I) Asian (A) Caucasian (C) Hispanic (H) Other (0)

(Circle one)

FATHER

MOTHER

Name: ___________________________________

Address:* _________________________________

Phone: * _________________________________

Religion: _________________________________

Parish: ___________________________________

Employer: ________________________________

Position: __________________________________

Work Phone: ______________________________

Cell Phone: ________________________________

Primary E-Mail ____________________________

*complete only if different from student

Parents Marital Status: (circle)

Married

Single

Divorced

Separated

Widowed

If divorced or separated reports should be sent to: _____Father

_____Mother _____Both

Parent Deceased: Father_______

Mother__________

Stepfather Name: ______________________________

Stepmother Name: ____________________

Student lives with (circle)

Father & Mother

Father

Mother Other__________________

Over 

Student Enrollment Information Form