New Student Registration Form - Burlington School District Form


Building a Learning Community
Student Legal name (Last, first middle)
Student Preferred name/nickname
Gender: M__ F__ DOB:______/______/________ Enrolling grade:__________ Year Student entered 9th grade: 20_______ Does not apply____
Enrolling school PK-5
Magnet* and Elementary Schools
My preferences for elementary
____Sustainability Academy* (Gr K-5)
____Integrated Arts Academy* (Gr PK-5)
___ Essential Early Education Program (Gr PK)
(1 to 6… 1 = top ; 6 = last )
___Champlain Elementary (Gr K-5) ___Edmunds Elementary (Gr K-5) ___C. P. Smith Elementary (Gr K-5) ___J.J. Flynn Elementary (Gr PK-5)
Please choose at least three schools
*Please fill out and return the Magnet School Application Form if you have selected a magnet school as your 1st choice.
Enrolling school 6-12 (Check one )
___Hunt Middle School (Gr 6-8) ___Edmunds Middle School (Gr 6-8) ___Burlington High School (Gr 9-12)
Name of Sibling(s) currently attending a School in the Burlington School District. Date of Birth
Name(s) of School(s)
Previous Education Information
Name of Last School Attended
Last School Attended Telephone School Type (check all that apply)
Public___ Private__ Pre-K___ Home education___
City / State of last School Attended
Country of last School Attended
USA___ Other_____________________________________
Grade Level at last attended school
Last Date Attended School
Special Services Information / Education Plan Please circle all that apply.
| IEP | ESL | Title I | 504 | EST | Other____________
Has the student ever attended school in the Burlington School District before? Yes____ No___
Student Place of Birth (City, State, Country)
Citizenship Status: US Citizen___ Other________________ Country of Citizenship (if not U.S.):_____________________________________
Student Home Telephone*
*Student Home telephone is the primary number to be used by Alert Now for regular notifications (School closings)
Physical Address of Student and Enrolling Parent/Guardian
Mailing Address (if different from Physical)
Street #, Street Name, Apt no, City, State, Zip
Street #, Street Name, Apt no, City, State, Zip
Ethnic Group and Race Categories. The Federal and State government requires that both these questions be answered and provides only the following categories for
ethnic group and race. If questions 1 and 2 are not answered, school personnel are required to make selection for both.
1. Is this student Hispanic or Latino? (choose only one)
Yes, Hispanic or Latino (A person of Cuban, Mexican, Puerto Rican, or Central American or other Spanish culture or origin, regardless of race.)
No, Hispanic or Latino
2. What is the student’s race (select all that apply)
American Indian/Alaskan Native (A person having origins in any of the original peoples of North and South America, including Central America, and who maintain tribal
affiliations or community attachment)
Asian (A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinents including, for example , Cambodia, China, India,
Japan, Korea, Malaysia, Pakistan, the Philippine Island, Thailand, and Vietnam.)
Black or African American ( A person having origins in any of the black racial groups of Africa)
Native Hawaiian/ Pacific Islander (A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.)
White (A person having origins in any of the original peoples of Europe, North Africa or Middle East.)
please provide documentation with this registration
Yes___ No______ If yes,
Are there court orders of which the school should be aware?
Student ID :______________________
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