Family Information Sheet - St. Mary School Marion, Ohio (Page 2 of 2) in pdf

Family Information Sheet - St. Mary School Marion, Ohio Page 2

Student 1

Name:

Grade:

Primarily resides with (please circle):

Father

Mother

Both Parents

Guardian/Custodian

 Does student currently have an IEP or service plan established?

yes

 Was student born outside US and has NOT finished 3 years of school in US?

yes

 Child’s first language

 Primary language spoken at home

Student 2

Name:

Grade:

Primarily resides with (please circle):

Father

Mother

Both Parents

Guardian/Custodian

 Does student currently have an IEP or service plan established?

yes

 Was student born outside US and has NOT finished 3 years of school in US?

yes

 Child’s first language

 Primary language spoken at home

Student 3

Name:

Grade:

Primarily resides with (please circle):

Father

Mother

Both Parents

Guardian/Custodian

 Does student currently have an IEP or service plan established?

yes

 Was student born outside US and has NOT finished 3 years of school in US?

yes

 Child’s first language

 Primary language spoken at home

Student 4

Name:

Grade:

Primarily resides with (please circle):

Father

Mother

Both Parents

Guardian/Custodian

 Does student currently have an IEP or service plan established?

yes

 Was student born outside US and has NOT finished 3 years of school in US?

yes

 Child’s first language

 Primary language spoken at home

Family Information Sheet - St. Mary School Marion, Ohio Page 2

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