Santa Clara Unified School District Student Registration Form

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SANTA CLARA UNIFIED SCHOOL DISTRICT
STUDENT REGISTRATION FORM
PermID
Grade
I.
STUDENT INFORMATION
Legal Name:
Last
First
Middle
Name
(if different than above)
Last
First
Cell Phone (
)
-
Female
Male
Birthplace: City
State
Country
Birthdate
/
/
US Citizen
Yes
No
US Entry Date
/
/
Ethnicity. What is the ethnicity of this student
? (Check one)
Hispanic or Latino
Not Hispanic or Latino
(Persons of Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture or origin, regardless of race.)
Race. What is the race of this student
(Check up to 5 racial categories)
The above part of the question is about ethnicity, not race. Regardless of what you have selected (above), please continue to answer
the following question by marking one or more boxes to indicate what you consider the race of this student to be.
American Indian or Alaskan Native (100)
Vietnamese (204)
Other Asian (299)
Other Pacific Islander (399)
(Persons having origins in any of the original
Asian Indian (205)
Hawaiian (301)
Filipino (400)
people of North, Central, or South America)
Chinese (201)
Laotian (206)
Guamanian (302)
Black/African American (600)
White (700)
(Persons having origins in any
Japanese (202)
Cambodian (207)
Samoan (303)
of the original peoples of Europe, North Africa,
Korean (203)
Hmong (208)
Tahitian (304)
or the Middle East)
Residence
Student resides with
(check all that apply)
Address
Unit
City
State
Zip Code
Mother
Father
Step Parent
Primary Phone No.
(
)
Legal Guardian(s)
Other
Type of Dwelling
(federally mandated)
Mailing Address
(if different from above)
Address
PO Box
Single Family (house, condo, mobile home, etc) (200)
City
State
Zip Code
Shelter/Transitional Housing Program (100)
Doubled-Up (120)
Foster Family/Kinship (210)
Motel/Hotel (110)
Unsheltered (car/campsite)(130)
Other
II.
PARENT / GUARDIAN INFORMATION
Name: Last
First
Middle
Parent Education Level
(indicate highest level completed)
Language Spoken
Not a High School Graduate
College Graduate
(1)
(4)
Work Phone No.
(
)
GED
Graduate School / Post
(1)
Cell Phone No.
(
)
Graduate
(5)
High School Graduate
(2)
Other
(
)
Some College
Declined to State
(3)
(6)
Email
@
Relationship to Student
Marital Status
Mother
Step Mother
Legal Guardian
Married
Single
Divorced
Widowed
Father
Step Father
Other
Name: Last
First
Middle
Parent Education Level
(indicate highest level completed)
Language Spoken
Not a High School Graduate
College Graduate
(1)
(4)
Work Phone No.
(
)
GED
Graduate School / Post
(1)
Cell Phone No.
(
)
Graduate
(5)
High School Graduate
(2)
Other
(
)
Some College
Declined to State
(3)
(6)
Email
@
Relationship to Student
Marital Status
Mother
Step Mother
Legal Guardian
Married
Single
Divorced
Widowed
Father
Step Father
Other
Please Complete The Information On The Other Side Of This Form
Rev 10.11.2012
Registration Form scusdRegFormV02.1 2011-2012

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