Fillable Student Information Sheet printable pdf download

Logan C ity S chool D istrict

For O ffice U se O nly:

Student I nformation S heet

Student I D N umber

Please a nswer e ach q uestion c ompletely

Date:

Last N ame ( Legal N ame):

First N ame:

Middle N ame:

Name y our s tudent s hould b e c alled i n s chool:

Grade:

Gender:

Social S ecurity N umber ( Optional):

Male

Female

Date o f B irth ( Month/Day/Year)

Place o f B irth:

Age:

City:

County:

State:

Home A ddress:

City:

Zip C ode:

Mailing A ddress:

City:

Zip C ode:

Home P hone:

Previously e nrolled i n L ogan C ity S chool D istrict?

Yes

Cell P hone:

Name o f S chool A ttended:

Year:

PREVIOUS S CHOOL(S)

Grade

Name o f S chool

Address

City

State

Phone N umber

RACE A ND E THNICITY

If y our c hild w as N OT b orn i n t he U nited S tates, p lease a nswer t he f ollowing:

Is t his s tudent H ispanic/Latino? ( Choose o ne o nly)

Years i n t he U nited S tates:

No, n ot H ispanic/Latino

Less t han 1 y ear

1 Y ear

2 Y ears

3 Y ears

More t han 3 y ears

Yes, H ispanic/Latino ( a p erson o f C uban, M exican,

Date f irst e ntered i nto t he U nited S tates:

Puerto R ican, S outh o r C entral A merican, o r o ther

Month:

Day:

Year:

Spanish c ulture o r o rigin, r egardless o f r ace.)

Date f irst e nrolled i n a U nited S tates S chool:

Month:

Day:

Year:

Country o f B irth:

American I ndian/Alaskan N ative

( a p erson h aving o rigins i n a ny o f t he o riginal p eoples o f N orth & S outh A merica ( including C entral A merica), a nd w ho m aintains t ribal a ffiliation o r c ommunity

attachment).

Tribal A ffiliation:

Goshute

Navajo

Paiute

Northwest B and S hoshone

Ute

other:

Asian ( a p erson h aving o rigins i n a ny o f t he o riginal p eoples o f t he F ar E ast, S outheast A sia, o r t he I ndian s ubcontinent i ncluding, f or e xample, C ambodia,

China, I ndia, J apan, K orea, M alaysia, P akistan, t he P hilippine I slands, T hailand, a nd V ietnam).

Black o r A frican A mercan ( a p erson h aving o rigin i n a ny o f t he b lack r acial g roups o f A frica).

Native H awaiian o r O ther P acific I slander ( a p erson h aving o rigins i n a ny o f t he o riginal p eoples o f H awaii, G uam, S amoa, T onga, o r o ther P acific I slands).

White ( a p erson h aving o rigins i n a ny o f t he o riginal p eoples o f E urope, t he M iddle E ast, o r N orth A frica).

Student R esidential S tatus:

PARENT(S)/GUARDIAN(S) I NFORMATION

INFORMATION F OR P ARENT/GUARDIAN

Both P arents

Legal G uardian(s)

First N ame:

Middle N ame:

Last N ame:

Father

Shelter

Mother

Temporary R esidence:

Relationship t o S tudent:

Cell P hone:

Foster P arent(s)

Hotel/Motel

Email A ddress:

Employer:

Grandparent(s)

Living w /Family

Group H ome

Other

Employers A ddress:

City:

State:

Zip C ode:

Work P hone:

Custody ( Check O ne):

INFORMATION F OR P ARENT/GUARDIAN

Divorced/Legally S eparated

First N ame:

Middle N ame:

Last N ame:

Yes

NOTE: C opy

of C ourt

If y es, w ho h as l egal c ustody:

Relationship t o S tudent:

Cell P hone:

Documents

Father

Email A ddress:

Employer:

Will B e

Mother

Required

Grandparents

Employers A ddress:

City:

Other

State:

Zip C ode:

Work P hone:

Revised 0 2/18/2015

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Student Information Sheet

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