Fillable Student Data Sheet - Wake County Public School System (Page 2 of 2) in pdf

Student Data Sheet - Wake County Public School System Page 2

Download a blank fillable Student Data Sheet - Wake County Public School System in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Student Data Sheet - Wake County Public School System with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

STUDENT DATA SHEET

Page 2 of 2

FAMILY INFORMATION (continued)

List names and grades of siblings attending WCPSS:

List names of non-school age siblings:

Apartment or Suite Number

Family’s Home Address

City

State

Zip Code

Apartment or Suite Number

Mailing Address

(if different from family’s home address)

City

State

Zip Code

With whom does the student reside? (Choose only one)

Mother only

Father only

Both parents

Legal custodian

Other (Please specify) ________________________

SCHOOL HISTORY

Does the student have an IEP?

Does the student have a 504 plan?

Yes

What language is spoken at home?

Does the student receive services through Title 1?

Yes

English

Other:__________________________________________

Has your child ever been enrolled in a Wake County school?

Yes

If “yes”, which school did your child attend? School name: __________________________________________ Start date __________ End date __________

Has your child ever been enrolled in a North Carolina school?

Yes

If “yes”, which school did your child attend? School name: __________________________________________ Start date __________ End date __________

Which school did your child last attend?

School name: __________________________________________ Start date __________ End date __________

Address of last school your child attended

Type of school last attended

Public

Private

Charter

Home

City

State

Zip Code

EMERGENCY HEALTH INFORMATION

Note any unusual physical conditions such as convulsion disorders, severe allergies or any condition for which the school should extend extraordinary care:

Emergency Contact’s First Name

Emergency Contact’s Last Name

Emergency Contact’s Phone Number

Emergency Contact’s Relationship to Child

(

)

Revised Jan. 2014