Enrollment Form Greenville County Schools Page 2
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1
2Questions:
Last School Attended:
__
_______________________
______________________________________________
___________
Public
__
Private
Name of School
Address of School
Grade
1. Social Security Number
_______________________
______________________________________________
__
(for verification of SUNS)
Home
__
Charter
Phone / Fax Numbers
Dates of Attendance
___________________
High School Students:
list all other high schools the student has attended, beginning with the most recent
Name of School
City, State
Grade(s)
Dates of Attendance
(optional)
_______________________________________________
_________________________
______
____________________
2. Has the student ever received
_______________________________________________
_________________________
______
____________________
ESOL (English for Speakers of Other
_______________________________________________
_________________________
______
____________________
Language) services?
Has the student ever taken the HSAP Test (SC high school exit exam)?
Yes
No
Not sure
Yes
No
If yes, please circle the name of the school the student was attending when the exam was taken.
3. Are the student's parents migrant
Siblings:
workers?
list all other children in this family who currently attend a Greenville County school
Last Name
First Name
Middle Name
Grade
School
Yes
No
___________________
___________________
_________________
______
_________________________________
4. Does the student live in a foster
home?
___________________
___________________
_________________
______
_________________________________
Yes
No
___________________
___________________
_________________
______
_________________________________
5. Does the student live in a group
___________________
___________________
_________________
______
_________________________________
home?
Emergency Contacts:
Yes
No
please provide information for people whom we could call in an emergency if we are unable to reach the parents
First and Last Name
Relationship to Student
Daytime Phone
___________________________
if yes, name of home
____________________________________________
______________________________
_________________________
____________________________________________
______________________________
_________________________
6. Is this student homeless?
____________________________________________
______________________________
_________________________
Yes
No
Student Support Services (Special Ed) Information:
Parents:
School Use:
Yes
N
Does the student receive Special Ed services:
o
1. If your child has medical issues that the school should be
If Yes:
IEP
504 Accommodation Plan
aware of, please list on the Emergency Information Form.
The student receives services from the following programs…
deaf/hard of hearing
mild/moderate mentally impaired
2. Please check your child's information on the Parent Portal
periodically and notify the school of any changes in
speech/language
moderate/severe mentally impaired
addresses, phone numbers, transportation status, emergency
physically impaired
specific learning disabilities
contacts, etc.
visually impaired
emotional/behavioral disordered
other health impaired
multiple
Parent signature: __________________________________
autism
other ________________________
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