Dodea Form 600 - Student Registration

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DEPARTMENT OF DEFENSE EDUCATION ACTIVITY
OMB No. 0704-0495
STUDENT REGISTRATION
OMB approval expires
Mar 31, 2016
SY
/
The public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, 4800 Mark Center Drive, Alexandria,
VA 22350-3100 (0704-0495). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it
does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION. RETURN COMPLETED FORM TO THE SCHOOL IN WHICH THE STUDENT IS ENROLLING.
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. Section 2164, and 20 U.S.C. Sections 921-932.
PRINCIPAL PURPOSE(S): To obtain information necessary to enroll students, administer school operations, and protect student health and welfare in DoD
operated dependent educational programs. Completed forms are covered by the DoDEA Dependent Children's School Program Files SORN located at
located at
ROUTINE USE(S): To Federal, State and local government officials to protect health and safety in the event of emergencies. The DoD Blanket Routine
Uses found at also apply to this collection.
DISCLOSURE: Voluntary; however, failure to disclose the information collected on this form may delay and/or prevent the enrollment of a child and/or the
delivery of educational and emergency services.
This form is completed by the sponsor, who is a parent, spouse, or a legal guardian, to request enrollment of his/her dependent(s) at a DoDEA school. A
dependent is a minor individual who has not completed secondary schooling and who is the child, stepchild, adopted child, ward or spouse of the sponsor.
The information collected is used internally to determine the student's eligibility to enroll on a tuition-free or tuition-paying basis, and whether the student is
space-required or space-available. It is also used to ensure that DoDEA makes available the appropriate classrooms, staffing, and supportive educational
services, places students in the appropriate grade, identifies students with special needs, and to ensure compliance with laws protecting student rights.
SECTION I - SPONSOR INFORMATION
1. TITLE
2.a. SPONSOR LAST NAME
b. SPONSOR FIRST NAME
c. SPONSOR MIDDLE NAME
3. RELATIONSHIP TO STUDENT
(Rank/Mr./Mrs.)
4. TELEPHONE NUMBERS
5. EMAIL ADDRESS
(Include Area Code or DSN)
a. HOME
b. DUTY/WORK
c. CELL
6. ORGANIZATION
7. PAY GRADE
8. ROTATION/DEPARTURE
(E-1/O-1/GS-1)
DATE
(YYYYMMDD)
9. ORGANIZATION MILITARY INSTALLATION/CITY/COUNTRY
10. MAILING ADDRESS
(Required)
11. PHYSICAL QUARTERS
(Enter only if different from mailing address)
(e.g., Local/APO/FPO)
(Street, City, etc.)
SECTION II - SPONSOR'S SPOUSE INFORMATION
1. TITLE
2.a. SPOUSE LAST NAME
b. SPOUSE FIRST NAME
c. SPOUSE MIDDLE NAME
3. RELATIONSHIP TO STUDENT
4. TELEPHONE NUMBERS
5. EMAIL ADDRESS
(Include Area Code or DSN)
a. HOME
b. DUTY/WORK
c. CELL
(If different)
6. ORGANIZATION MILITARY INSTALLATION/CITY/COUNTRY
SECTION III - FIRST LOCAL EMERGENCY CONTACT AND RELEASE INFORMATION
The person identified will be contacted if there is an emergency and the sponsor/spouse/legal guardian cannot be contacted. I permit the dependent that I
am registering with this form to be released to the emergency contact identified in this section if I or my spouse are not available.
1. LAST NAME
2. FIRST NAME
3. TITLE
4. RELATIONSHIP TO STUDENT
(Not sponsor or spouse)
5. HOME TELEPHONE
6. DUTY/WORK TELEPHONE
7. CELL PHONE
SECTION IIIA - SECOND LOCAL EMERGENCY CONTACT AND RELEASE INFORMATION
The person identified will be contacted if there is an emergency and the sponsor/spouse/legal guardian or the first local emergency contact cannot be
contacted. I permit the dependent that I am registering with this form to be released to the emergency contact identified in this section if I or my spouse are
not available.
1. LAST NAME
2. FIRST NAME
3. TITLE
4. RELATIONSHIP TO STUDENT
(Not sponsor or spouse)
5. HOME TELEPHONE
6. DUTY/WORK TELEPHONE
7. CELL PHONE
SECTION IIIB - PERMANENT STATESIDE EMERGENCY CONTACT INFORMATION
1. LAST NAME
2. FIRST NAME
3. TITLE
4. RELATIONSHIP TO STUDENT
5. HOME TELEPHONE
6. DUTY/WORK TELEPHONE
7. CELL PHONE
8. PERMANENT STATESIDE ADDRESS
DoDEA FORM 600, MAR 2013
REPLACES SD FORM 600, WHICH IS OBSOLETE.
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