Student Enrollment Form - California

Student Na me:
Date of Birth:
LOS ANGELES UNIFIED SCHOOL DISTRICT
STUDEN T ENROLLMEN T FORM
D. STUDENT EDUCATIONAL INFORMATION (Continued)
D.
Did you attempt to enroll the child in a different school in Los Angeles County for the current or preceding year?
Yes No
If No, skip to E.
1.
If
Yes
, what was the outcome?
Accepted Denied Wait Listed Other
2.
Please provide name of school:
E.
Is student currently under an expulsion order?
Yes No
If Yes, please list the name of the school district
F. Date of first U .S . scho ol enr oll m ent excluding preschool (mm/dd/yy)
G.
Date of first C ali f orni a sc ho ol enr ol lm en t excluding preschool (mm/dd/yy)
E. ADDITIONAL HOUSEHOLD INFORMATION
1.
Court Orders
A.
Are the re an y court or ders you wis h to noti f y th e scho ol abo ut reg ar ding legal c usto d y, physical c ust od y o r restri c te d cont act wi th the sch ool or chi ld ?
Yes No
If Yes , a copy of the co ur t or d er mus t be pr o v id ed t o the sc h ool.
2.
Student Lives with Foster Family
Yes No
If Yes,
Relative Caregiver
If Yes, please provide Notification of Placement Status Form
Non-Relative Caregiver
Children’s Social Worker (CSW) Telephone Number (ext)
3.
Complete these three rows if student’s address is a licensed children’s institution/family foster agency/group home/adult residential facility.
A.
B.
C.
D.
Facility Name Facility Type License Number Contact Person
E.
F.
G.
Facility Telephone Number
Alternate Telephone Number
Facility Street Address: Number
Street
Apt./Unit
City
Zip Code
H.
I.
Children’s Social Worker (CSW)
Telephone Number & ext.
4.
Does the student have any relatives who ar e all or part American Indian or Alaska Native?
Yes No
5.
Has the student’s parent or legal guardian worked in one or more of the following industries in the last three years (agriculture, dairy, fishery, food
processing/packing, or livestock)? If you respond Yes, you will be contacte d at home rega rding the Migr ant Education Program and whether your child
may qualify for its free academic assistance and health benefits.
Yes No
F. ADDITIONAL FAMILY INFORMATION
(L A U SD M AX : Caretaker Inform ation )
PARENT/LEGAL GUARDIAN/CAREGIVER:
1.
2.
Legal Name: Last
First
Middle
Other Names Used
3.
Home Address (if different than student’s) Number Street Apt/Unit City Zip Code
4.
5.
6.
Day
7.
Home Telephone Number
Cell/Pager Number
Work Telephone Number
Evening
E-mail Address
8.
Preferred Correspondence Language
English
Spanish
Armenian
Chinese
Farsi
Filipino
Korean
Russian
Vietnamese
9.
Highest Level of Education Completed
Not a High School Graduate
High School Graduate or Equivalent
Some College (includes AA Degree)
Colle ge Gra du at e
Graduate School/Post Graduate Training
Decline to State or Unknown
10.
Does the student live with this individual?
Yes No
11.
Relationship to Student:
PARENT/LEGAL GUARDIAN/CAREGIVER:
1.
2.
Legal Name: Last
First
Middle
Other Names Used
3.
Home Address (if different than student’s) Number Street Apt/Unit City Zip Code
4.
5.
6.
Day
7.
Home Telephone Number
Cell/Pager Number
Work Telephone Number
Evening
E-mail Address
8.
Preferred Correspondence Language
English
Spanish
Armenian
Chinese
Farsi
Filipino
Korean
Russian
Vietnamese
9.
Highest Level of Education Completed
Not a High School Graduate
High School Graduate or Equivalent
Some College (includes AA Degree)
Colle ge Gra du at e
Graduate School/Post Graduate Training
Decline to State or Unknown
10.
Does the student live with this individual?
Yes No
11.
Relationship to Student:
Page 2/3
Free Download

Student Enrollment Form - California PDF

Favor this template? Just fancy it by voting!
  •  
  •  
  •  
  •  
  •  
(0 Votes)
0.0
Related Forms
  •  
  •  
  •  
  •  
  •  
3 Page(s) | 1881 Views | 40 Downloads
  •  
  •  
  •  
  •  
  •  
2 Page(s) | 988 Views | 8 Downloads
  •  
  •  
  •  
  •  
  •  
1 Page(s) | 825 Views | 23 Downloads
  •  
  •  
  •  
  •  
  •  
3 Page(s) | 2142 Views | 29 Downloads
  •  
  •  
  •  
  •  
  •  
4 Page(s) | 1422 Views | 4 Downloads