Student Registration Form
ADVERTISEMENT
1
2
3
4S
T
U
D
E
N
T
R
E
G
I
S
T
R
A
T
I
O
N
S
T
U
D
E
N
T
R
E
G
I
S
T
R
A
T
I
O
N
F
O
R
M
F
O
R
M
Student Name: _____________________________________________
School Name: ______________________________________________
_
Shaded Areas for Office Use Only
Student OEN (Ontario Education Number): _ _ _ _ _ _
_ _
Tax Support Public Board
If no please contact
or call 1-866-296-6722 to register.
Yes
No
Yes
No
Immunization
Student No.
Optional Attendance
Yes
No
Yes
No
Date of Birth Verified
Proof of Citizenship
Yes
No
Yes
No
Proof of Address
Trillium Entry Date
(if applicable)
Yes
No
International Student
ESL Start
Track
Grade
Date of Entry
Program
Home Form
ESL End
(PLEASE PRINT)
STUDENT INFORMATION:
Last Name _____________________
First Name ___________________
Middle Name ________________
(Legal)
(Legal)
(Legal)
Last Name _____________________
First Name ___________________
Middle Name ________________
(Preferred)
(Preferred)
(Preferred)
_ _ _ _ / _ _ / _
Male
Female
Self-Identify as _______________
Date of Birth
_
Year
Month
Day
Student Cell Phone No. __ __ __ - __ __ __ - __ __ __ __ E-mail Address_____________________________________
Date of Birth Verification: Birth Certificate
Canadian Citizenship
Immigration Papers
Passport
Other
Has the student ever been registered at a school within the Halton District School Board?
Yes
No
If Yes, provide the name of the school within the Halton DSB most recently attended:
_______________________________________________________________________ Last grade attended _________
Has the student ever been registered at a school within the Province of Ontario?
Yes
No
If Yes, provide the name of the school most recently attended:
If No, provide the name of the school most recently attended outside of Ontario:
_______________________________________________________________________ Last grade attended _________
(_ _ _) _ _ _ - _ _ _ _
School Address:
_____________________________
School Phone Number:
(_ _ _) _ _ _ - _ _ _ _
_____________________________
School Fax Number:
_____________________________
School E-mail: ____________________________
Name of School Board:
____________________________________________________________________________
Is the student currently suspended from school?
Yes
No
Is the student currently expelled from a school or board?
Yes
No
Has the student ever been previously suspended/expelled from a school or board?
Yes
No
SPECIAL EDUCATION:
Has the student ever been identified through an IPRC and/or received special education support? Yes
No
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Life