Student Enrollment Sample Form

New Student Enrollment Form
Date: _________________ School: _________________________
Date: _________________ School: _________________________
Mother Father
Legal Guardian
Last Name: First Name:
Middle Initial:
Home Phone:
Work Phone: Parent Cell Phone: Other #:
Marital Status:
Employer: Highest Education Received: Speaks English?
YES
NO
Email Address:
Works on Federal Property?
YES
NO
Lives on Federal Property?
YES
NO
Mother Father
Legal Guardian
Last Name: First Name:
Middle Initial:
Home Phone:
Work Phone: Parent Cell Phone: Other:
Marital Status:
Employer: Highest Education Received: Speaks English?
YES
NO
Parent Email Address:
Works on Federal Property?
YES
NO
Lives on Federal Property?
YES
NO
EMERGENCY CONTACT(S)
Can student be picked
up by this person
Name:
Relationship: Contact Number(s):
YES
NO
Name:
Relationship: Contact Number(s):
YES
NO
Name:
Relationship: Contact Number(s):
YES
NO
Name:
Relationship: Contact Number(s):
YES
NO
Name:
Relationship: Contact Number(s):
YES
NO
Name:
Relationship: Contact Number(s):
YES
NO
PARENT/GUARDIAN RESIDENCY NOTICE
To be enrolled in Atlanta Public Schools, students must reside full-time in the City of Atlanta with their natural parent(s), legal
guardian(s), or legal custodian(s). For the purpose of this policy, a resident is defined as an individual who is a full-time occupant of a
dwelling located in the City of Atlanta and who, on any given school day, is likely to be at their stated address when not at work or
school. A person who owns property in the City of Atlanta, but does not reside in the City of Atlanta, is not considered a resident.
Parents are required to notify Atlanta Public Schools within fourteen (14) days if there is a change in residence.
Representatives of Atlanta Public Schools may visit the home to verify residency. A student enrolled in Atlanta Public Schools under
falsified information is illegally enrolled and will be immediately withdrawn from school. Parents and Guardians making false statements
or submitting false documentation is a violation of O.C.G.A. §16-9-2, §16-10- 20 and/or §16-10-71 of the criminal laws of the State of
Georgia and punishable by a fine of not more than $1,000.00 or by imprisonment for not less than one nor more than five years, or
both. O.C.G.A. 16-10-71.
PARENT/GUARDIAN SIGNATURES
I SWEAR or AFFIRM THAT THE INFORMATION I HAVE PROVIDED IS TRUE AND CORRECT.
_____________________________________
Parent/Legal Guardian Signature
Date:
___________________________________
Parent/Legal Guardian Signature
Date:
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Student Enrollment Sample Form PDF

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