Student Data Collection Form printable pdf download

STUDENTS

09.14 AP.2

Student Data Collection Form

ENR

Last Name: __________________________________

Homeroom: ____________________

First Name: _________________________________

Race: _________________________

Middle Name: _______________________________

Sex: __________________________

Physical/E911 Address: ________________________

DOB: _________________________

Mailing Address: _____________________________

T-code: _______________________

City: ______________________________________

Bus:

AM________PM_________

State: _________________ Zip: _________________

Area Code: ____________________

Social Security #: _____________________________

Phone #: _______________________

Hispanic/Latino  or Not Hispanic/Latino 

Ethnicity (must choose one)

White 

Black or African American  American Indian or Native Alaskan 

Choose all that apply:

Native Hawaiian or Pacific  Asian 

Who’s identifying student’s race?

Parent/Guardian 

Child 

Observer 

Unknown 

First Language Your Child Began to Speak: ____________ Country of Origin: _______________

Language Spoken Most Often by Student in the Home: __________________________________

Language Spoken Most Frequently in the Home/Primary Language Spoken to Child: ___________



Yes or

This student was expelled and/or adjudicated guilty/convicted of crimes.

(If you answered yes to the previous question please fill out policy (09.12 AP.23)

GUARDIAN INFORMATION COLLECTION FORM

Guardian #1

Guardian #2

Full Name: ___________________________ Full Name: ___________________________

DOB: ________________________

Physical/E911 Address: _________________ Physical/E911 Address: _________________

Mailing Address: ______________________ Mailing Address: ______________________

City: ____________ State: ____ Zip: ______ City: ____________ State: ____ Zip: ______

Phone: _______________________________ Phone: _______________________________

Relation: ____________________________

Employer: ___________________________

Address: _____________________________ Address: _____________________________

Work Phone: _________________________

Race: _______ Primary Language: ________

E-Mail Address: ______________________

Please list any siblings living at home and the school, if any they attend.

_________________________________________

__________________________________________

_________________________________________

__________________________________________

HOME DIRECTIONS

Please give directions to your home: ________________________________________________

_____________________________________________________________________________

*Notify the school when there is a change of address, phone, etc.

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Student Data Collection Form

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