Student Registration Form - Stafford County Public Schools
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1
2SCPS Student ID
Current Enrolling SCPS
Family ID
Student Registration Form - Part A
To Be Completed by Parent or Guardian
Student Legal Name (as it appears on the birth certificate)
Student Nickname
Student Previous Name (if any)
Last
First
Middle
Last
First
Middle
Date of Birth (mm/dd/yyyy)
Social Security Number (Optional)
Grade Level of Registration
Gender
-
-
Male
Female
________/______/________
Residence Address of Student
Street
Apt No.
City
State
Zip Code/Suffix
Student Home Telephone
Unlisted
(_______) _______ - _________
Mailing Address (if different from above)
Street / P.O. Box No.
Apt No.
City
State
Zip Code/Suffix
Enrolling Parent
Relationship to Student
Mother
Father
Legal Guardian
Other (specify) ___________________________________
Last
First
Middle
Address (If different from student)
Home Telephone
Cell
E-mail
Federal Employee
Yes
No
Unlisted
(_______) ________ - ___________
(_______) ________ - ___________
Employer Name
Telephone
Street / P.O. Box No.
City
State
Zip Code/Suffix
(_______) _______ - _________
Other Parent
Student Resides With
Yes
No
Relationship to Student
Mother
Father
Stepmother
Stepfather
Legal Guardian
Other (specify) _____________________
Last
First
Middle
Address (If different from student)
Home Telephone
Cell
E-mail
Federal Employee
Yes
No
Unlisted
(_______) ________ - ___________
(_______) ________ - ___________
Employer Name
Telephone
Street / P.O. Box No.
City
State
Zip Code/Suffix
(_______) _______ - _________
Who has Legal Custody?
Both Parents
Mother
Father
Other (specify) ________________________________________
Are there special visitation rights (during school hours)?
Yes
No If yes, please specify________________________________________________________ Attach a copy of the Court Order.
Additional Contacts
Last
First
Middle
Telephone
Relationship to Student (specify)
(_______) _______ - _________
Last
First
Middle
Telephone
Relationship to Student (specify)
(_______) _______ - _________
Ethnic Group and Race Categories
Other Children in Family
The federal government requires that both these questions be answered and provides only the following categories for
Name
Date of Birth
ethnic group and race. If either question is not answered, school personnel are required to complete selection.
1. Is this student Hispanic or Latino? (Choose only one)
2. What is the student's race? (Choose one or all that apply)
___________________________________
_____/_____/_____
American Indian or Alaska Native
No, not Hispanic or Latino
___________________________________
_____/_____/_____
Asian
Yes, Hispanic or Latino
(A person of Cuban, Mexican, Puerto Rican, South or
Black or African American
Central American, or other Spanish culture or origin,
___________________________________
_____/_____/_____
regardless of race.)
Native Hawaiian or Other Pacific Islander
___________________________________
_____/_____/_____
White
v1.1
Page 1 of 2
Continue to Part B
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