Student Enrollment Sample Form
New Student Enrollment Form
Date: _________________ School: _________________________
Date: _________________ School: _________________________
All new students must provide proof of residence upon enrollment and current students must provide proof of residence annually.
Parent/Guardian Checklist of Documents:
__ BIRTH CERTIFICATE __ SOCIAL SECURITY CARD/OBJECTION __ IMMUNIZATION CERTIFICATE
__ EYE, EAR & DENTAL CERTIFICATE __ PHOTO IDENTIFICATION __ WITHDRAWAL FORM
__ REPORT CARD/TRANSCRIPT __ PROOF OF RESIDENCY** __ RESIDENCY AFFIDAVIT
__ STANDARDIZED TEST SCORES
(CRCT, EOCT, GHSGT)
**Please visit the APS website (http://www.atlanta.k12.ga.us/Page/34748) for Proof of Residency Documents
SCHOOL USE ONLY
STUDENT HOUSEHOLD NAME:
Student ID #:______________ Grade:______ Homeroom: __________ Counselor Name:________________ Advisor/Teacher:_________________
Transportation: ___ Bus #:____________ ___Walker ___ Car ___ Day Care Bus ___After-School Program
__Gifted __ Special Education __Student Support Team __ESOL ___ 504
Conditional enrollment is only available during the school year. Students pre-enrolling or enrolling before school starts are
not eligible for Conditional Enrollment.
__ 30 Day Conditional Enrollment Granted __ 7 Day Conditional Enrollment Granted Ending Date__________________
Items Needed To Complete Enrollment:
__ BIRTH CERTIFICATE __ SOCIAL SECURITY CARD __ IMMUNIZATION CERTIFICATE
__ EYE, EAR & DENTAL CERTIFICATE __ PHOTO IDENTIFICATION __ WITHDRAWAL FORM
__ REPORT CARD/TRANSCRIPT __ PROOF OF RESIDENCY __ RESIDENCY AFFIDAVIT
__ PROOF OF GUARDIANSHIP
School Records requested from______________________________________ Date:______________ Received:_____________
School Records requested from______________________________________ Date:______________ Received:_____________
____________________________________________________ Date:______________
Registration Personnel
STUDENT INFORMATION
Last
Name:
First
Name:
Middle
Name:
Suffix:
Grade: Gender: Current
Age:
Date of
Birth:
Social
Security #:
State of
Birth:
Country of
Birth:
(If not USA)
Date Entered
US:
Date Entered
US School:
Home Phone:
Student Cell Phone:
Home Address: (Street Address)
Apt #:
City: State: Zip:
Does Student Reside in Federally
Subsidized Housing?
Yes
No
Does Student have an IEP
(Special education)?
Yes
No
Is Student in ELL/ESOL Program?
Yes
No
Was/Is student in
Gifted/Challenge program?
Yes
No
Does student have a
504 Plan?
Yes
No
Was/Is student involved in the
Student Support Team?
Yes
No
Has the Family lived in another
county in the last three (3) years?
Yes
No
If yes, what is the date your family
arrived in Fulton county?
What language(s) did the student first
learn to speak?
What language(s) does the student
speak at home?
What language(s) does the student
speak most often?
What is your child’s race? (Select all that apply)
American Indian or Alaska
Native (A person having origins in any of the original peoples of
North and South America (including Central America), and who maintains a tribal affiliation or
community attachment.)
Asian
(A person having origins in any of the original peoples of the Far East, Southeast Asia, or
the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia,
Pakistan, the Philippine Islands, Thailand, and Vietnam.)
Black or African American
(A person having origins in any of the Black racial groups of Africa
– includes Caribbean Islanders and other of African origin.)
Native Hawaiian or Other Pacific Islander
(A person having origins in any of the original
peoples of Hawaii, Guam, Samoa, or other Pacific Islands.)
White
(A person having origins in any of the original peoples of Europe, the Middle East, or North
Africa.)
Is your child Hispanic/Latino?
No, Not Hispanic/Latino
Yes, Hispanic/Latino (A person of
Cuban, Mexican, Puerto Rican, South
American, Central American, or other
Spanish Culture or origin, regardless of
race.
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