Enrollment Form Greenville County Schools
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1
2Student Enrollment Form
GeoCode
Entry Date
Greenville County Schools
Please print answers to all questions:
Form 130-10/9.2010
________________________
Preferred Phone # for School Messages
______________________________
________________________
________________________
__________
Note :
The phone number listed above will receive
Last Name
First Name
Middle Name
Suffix (Jr, III, etc)
automated messages from the school. This can be a
home or cell number.
____________________________________________________
____________________________
_______________
________________________
Home Address
City
Zip
Alternate Phone Number
Mailing Address, if different: ____________________________________________________________________________________________________
Has student ever attended another school in
Ethnicity and Race
Place of Birth
Transportation
Greenville Co?
If yes, name school on
__
__
Bus:
Other:
1) Are you Hispanic or Latino?
Yes
No
blank below:
yes
no
____________________________________
____________________________
__
__
2) Race:
(check all that apply)
Asian
OR
city, state
country if not US
morning
walk
Birthdate
Grade Level
Gender
__
__
American Indian or Alaskan Native
Black
afternoon
car
/
/
M
F
__
__
Native Hawai'ian or Pacific Islander
White
never
daycare bus
Student Lives With:
*
*
*
*
Both Parents
Mother
Father
Stepparent
Foster Parent
Guardian
Other
Alone
(check all that apply)
Legal Father of Student:
(parent listed on child's birth certificate or court-issued custody document)
Legal Mother of Student:
(parent listed on child's birth certificate or court-issued custody document)
__________________
__________________
__________________
__________________
__________________
__________________
Last Name
First Name
Middle Name
Last Name
First Name
Middle Name
________________________________________
________________
________________________________________
________________
Address (if different from student's)
Home Phone
Address (if different from student's)
Home Phone
_____________________
________________
________________
_____________________
________________
________________
City, State
Zip
Cell Phone
City, State
Zip
Cell Phone
________________________________________
________________
________________________________________
________________
Employer
Work Phone
Employer
Work Phone
Signature
Signature
_____________________________________________
______________________________________________
if available
if available
*
If student lives with someone
(
)
_________________________
Stepparent
Foster Parent
Guardian
Other
other than natural parent:
(Appropriate documents should be presented at time of enrollment)
Parents: If you want a stepparent to have access (verbal or written) to
your child's records, you will need to complete a "Consent for Access"
__________________________________
form in the presence of a school staff member.
Last Name
First Name
___________________________________
_______________________
_______________________
_______________________
Employer
Home Phone
Cell Phone
Work Phone
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