Dodea Form 600 - Student Registration Page 2
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2SECTION IV - STUDENT INFORMATION
1.a. LEGAL LAST NAME
b. LEGAL FIRST NAME
c. LEGAL MIDDLE NAME
d. PREFERRED FIRST NAME
(Include Jr./Sr./II)
4. DATE OF BIRTH
2. STUDENT GRADE
3. GENDER
5. STUDENT ETHNICITY: HISPANIC OR LATINO
(X one)
(X one)
(YYYYMMDD)
M
F
Y
N
6. STUDENT RACE
(X all that apply)
a. American Indian or Alaska Native
c. Black or African American
e. Native Hawaiian or Other Pacific Islander
b. Asian
d. White
7. STUDENT CELL PHONE
9. PASSPORT NUMBER
10. PASSPORT EXPIRATION
8. STUDENT EMAIL ADDRESS
(May be assigned by school)
(Include Area Code)
DATE
(H.S. only)
(YYYYMMDD)
11. DOES THE STUDENT SPEAK A LANGUAGE OTHER
13. WHAT IS THE HOME
12. IS THERE AN ADULT WHO SPEAKS A LANGUAGE
THAN ENGLISH IN THE HOME?
OTHER THAN ENGLISH?
LANGUAGE?
(X one) (If Yes, what language?)
(X one) (If Yes, what language?)
Y
N
Y
N
SECTION V - STUDENT HEALTH INFORMATION
The information for physical and medical facility is for use in an emergency. Other information is collected to ensure compliance with immunization
requirements and provide staff with the student's medical background.
1. PHYSICIAN OR MEDICAL FACILITY NAME
2. PHYSICIAN OR MEDICAL FACILITY TELEPHONE NUMBER
(Include Area Code or DSN)
3. FOR NEW STUDENT: I have provided school officials with the DoDEA Form 2942.0-M-F1, "DoDEA Student Health History."
Y
N
4. FOR RETURNING STUDENT: I have provided school officials with the DoDEA Form 2942.0-M-F2, "DoDEA Returning Student Health History."
Y
N
5. IMMUNIZATIONS
(Only for new student) (X and initial)
I have provided or
will provide a copy of the Immunization Record as soon as possible to meet the provision allowing 30-calendar day
grace period to obtain required immunizations.
6. OTHER CONCERNS
7. DOES THE STUDENT HAVE A HEALTH CONDITION REQUIRING POSSIBLE EMERGENCY CARE?
(X one)
Y
N
(If Yes, specify:)
SECTION VI - VERIFICATION
1. I AM REGISTERING
(how many) STUDENT(S).
2. I declare under penalty of perjury that the statements made by me on this form are true, complete and correct.
a. SIGNATURE OF SPONSOR/SPOUSE/LEGAL GUARDIAN
b. DATE
(YYYYMMDD)
SECTION VII - FINAL DETERMINATION
The final determination for placement of a child in a DoDEA school is the responsibility of DoDEA. You may be provided the opportunity to personally
explain, refute, or clarify any information before a final decision is made.
SECTION VIII - SCHOOL USE
1. STUDENT NUMBER
2. STUDENT GRADE
3. ENROLLMENT CODE
4. SCHOOL CODE (DODAAC)
5. SCHOOL NAME
6. FIRST DAY STUDENT STARTS SCHOOL
(YYYYMMDD)
7. ORDERS ON FILE/VERIFIED
8. BIRTH DATE VERIFIED
(X one)
(Birth Certificate or Passport for Pre-Kindergarten, Sure Start, Kindergarten,
First Grade)
N
Y
N
Y
9. I verify that the information is correct.
a. SIGNATURE OF REGISTRAR
b. DATE
(YYYYMMDD)
DoDEA FORM 600 (BACK), MAR 2013
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