Student Registration Application printable pdf download

WALLINGFORD-SWARTHMORE SCHOOL DISTRICT – STUDENT REGISTRATION APPLICATION

STUDENT INFORMATION

EVER ENROLLED IN WSSD?

Yes

FULL LEGAL NAME: __________________________________________________________________________

_____________________ GENDER:

LAST

FIRST

MIDDLE

NICKNAME

Yes

HISPANIC/LATINO

RACE (

circle all that apply)

American Indian/Alaska Native

9 - Asian

3 - Black/African American

10 - Native Hawaiian/Other Pacific Islander

5 - White

DATE OF BIRTH: __________________________

CITY OF BIRTH: ____________________________________

STATE OF BIRTH: ____________

COUNTRY OF BIRTH: _________________________________

DATE OF PA RESIDENCE: ________________________________

DATE 1

ENROLLED IN A U.S. SCHOOL: __________________________________

GR 09 ENTRY DATE: ________________________________

REPEATING LAST YEAR:

Yes

SPECIAL ED:

Yes

FOREIGN EXC:

MIGRANT:

IMMIGRANT:

HOME LANGUAGE___________________________________

PRESENT ADDRESS: ____________________________________________________________________________________________________________

HOME PHONE: ______________________________________

Street

City

State

Zip

PREVIOUS HOME ADDRESS: _________________________________________________________________________________________

PREVIOUS SCHOOL: _____________________________________________

LAST DAY OF ATTENDANCE AT PREVIOUS SCHOOL: ________________ LAST GRADE ATTENDED: ___________ PREV. SCHOOL ADDRESS:___________________________________________________________

PARENT/GUARDIAN INFORMATION (List by who should be contacted first)

STATUS (Circle one):

SINGLE

MARRIED

SEPARATED¹

DIVORCED¹

GUARDIAN¹

FOSTER²

PARENT/GUARDIAN 1: (Title/Name) _____________________________________________________ RELATIONSHIP: _______________ SPOUSE: __________________________________

ADDRESS (H) ____________________________________________________________ PHONE (H): _________________________ (C): ____________________________

ADDRESS SAME AS ABOVE:

EMAIL: _____________________________________________________________________ EMPLOYER: ________________________________________________________PHONE (W):____________________________

PARENT/GUARDIAN 2: (Title/Name) _____________________________________________________ RELATIONSHIP: _______________ SPOUSE: __________________________________

ADDRESS (H) ____________________________________________________________ PHONE (H): _________________________ (C): ____________________________

ADDRESS SAME AS ABOVE:

EMAIL: _____________________________________________________________________ EMPLOYER: ________________________________________________________PHONE (W):____________________________

SIBLING/ADDITIONAL RESIDENT INFORMATION

OFFICE USE ONLY

NAME

SCHOOL

AGE

GRADE

Deed, Lease, Tax

Multiple Occupancy

Act 26

Agreement of Sale

Intent to Move

Immunizations