Student Registration Form - Jefferson Parish Public School System printable pdf download

Student Registration Form - Jefferson Parish Public School System

SCHOOL USE ONLY

Date of Entry ____/____/____

Grade _____

Homeroom ______________________________

Records checklist:

Birth Certificate*

Louisiana Universal Certificate of Immunization*

Withdrawal Form/Report Card*

Custody Papers (if applicable)*

Transcripts (HS)

Proof of Residence 1*

Standardized Test Scores

Discipline Records

Proof of Residence 2*

IEP/Evaluation Form

504/IAP

Other: ________________________

* required items

STUDENT REGISTRATION FORM

Last School Attended: __________________________________ City: _____________________ State: _____ Zip: ____________

Parish: _____________________________________

HOME LANGUAGE SURVEY

Is a language other than English spoken in your home?

Yes (which language? _____________________________)

Does your child communicate in a language other than English?

Yes (which language? _____________________________)

If yes to above, which language did your child learn first? _____________________________

If other than English, in which language do you prefer to receive information from the school? _____________________________

STUDENT’S INFORMATION

Last Name:

First Name:

Middle:

Address:

City:

Zip Code:

Nickname:

Grade:

Gender:

Male

Female

Date of Birth:

Student Ethnicity: (Check all that apply. If more than one is checked, circle the race you would like us to record as student’s primary race)

0 White

1 Black

2 Hispanic

3 Asian

4 Native American/Alaskan Native

5 Hawaiian/Pacific Islander

Transportation:

Walker/Car Rider

Student Vehicle

Regular School Bus

Special Education School Bus

Afterschool Childcare Program at the School

Other: __________________________________

Check all that apply:

Special Education Services/Student has an IEP (Exceptionality _____________________________________________)

Receives 504 Accommodations

Student is out of his school attendance zone (Reason: ______________________________)

List any health conditions, allergies, medications, or diet restrictions we should be aware of: __________________________________________

______________________________________________________________________________________________________________________

Prior Education Experience to Kindergarten (Complete if registering for Pre-K or K) Select 1:

(K01) Public Pre-K

(K02) Non-Public Pre-K

(K03) Licensed Childcare

(K04) Family Day Care Home Program

(K05) Head Start

(K06) Tribal

(K07) Home (no Pre-K)

Revised: 5/5/17

Student Registration Form - Jefferson Parish Public School System

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