School Enrollment / Residency Form
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1
2FREMONT PUBLIC SCHOOL ENROLLMENT / RESIDENCY FORM
Student _____________________________________________________________________________________
FULL LEGAL NAME (as listed on birth certificate)
last
first
middle
other
Sex: Male Female
Birth date: ________________
Birthplace City ______________________, State ______
Grade __________
Previous School Name & Address
___________________________________________________________________________________________
Has student ever been enrolled in Fremont Public Schools?
Y
N
When? ______
Has student ever received Special Education Services?
Y
N
Is the student currently receiving Special Education Services?
Y
N
Has student ever been suspended or expelled from any school district?
Y
N
Is there anything pending?
Y
N
Health Issues? yes or no
Please explain ______________________________________________________
Do you reside in the Fremont School District? Yes or No
If no, which district do you live in? _________________
What is your ethnic group? __________________________ What county do you live in? _____________________
What is your native language? _______________________ What township do you live in? ___________________
With whom does student live?
Both parents
Father
Mother
Grandparents
Guardian
Foster Home
Father & Stepmother
Mother & Stepfather
Other relative
Other non-relative
Ward of the Court
Who has legal custody? ___________
Any restrictions school should be aware of? _________________
Restrictions____________________________________________________________________________
Is either parent currently active in the military? ____________
STUDENT RESIDES WITH:
Primary Guardian _____________________________________________________________________________
Family 1
Last name
First
relationship to student
Address______________________________________________________________________________________
____________________________________________________________________________________________
City
State
Zip
Mailing address (If different) _____________________________________________________________________
Home Phone ______________________
Cell______________________________
Employer _________________________________________________ Phone ____________________________
Email address _________________________________________________________
Spouse ______________________________________________________________________________________
Family 1
Last name
First
relationship to student
Cell
Phone____________________________
Employer _________________________________________________ Phone ____________________________
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