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Student Registration Form - Alexandria City Public Schools

1 Student Registration Form - Alexandria City Public Schools
2 Student Registration Form - Alexandria City Public Schools
Revised 3/2015 Communicaons Oce dnb
STUDENT REGISTRATION FORM
•
Alexandria City Public Schools
Student’s Last Name: First Name: Middle Name:
Student Address: Street Apt #
City State Zip
r Male r Female Date of Birth: Mo: Day: Year: Country of Birth: Grade:
*Is this student Hispanic or Lano? (choose only one)
*What is the student’s race? (choose one or more)
Last School Aended: r Public r Private
Address: City State Zip
If not an Alexandria City school, has student EVER aended Alexandria City Public Schools? r Yes r No
If Yes, please provide the following: School: Year: Grade:
If a language other than English is spoken in the student’s home, what is that language?
r No,notHispanicorLano r Yes,HispanicorLano(personofCuban,Mexican,PuertoRican,SouthAmerican,
CentralAmerican,orotherSpanishcultureororigin,regardlessofrace)
r AmericanIndian/Alaskan
r Asian
r Spanish rAmharic r Arabic rOther(pleasespecify)
r BlackorAfricanAmerican
r NaveHawaiianorOtherPacicIslander
r White(apersonhavingoriginsinanyoftheoriginal
peoplesofEurope,theMiddleEastorNorthAfrica)
Parent/Guardian:
Is the City of Alexandria your legal residence? r Yes r No
IfNo,hasanexcepontopolicybeenapproved? r Yes r No
Parent/Guardian #1:
HomePhone:( ) - CellPhone:( ) - EmailAddress:
r Father r Stepfather r Legal Guardian
r Mother rStepmother r Foster Parent
Other(pleaseindicaterelaonship):
Address: rAddressisthesameasstudent’saddressabove
Street Apt #
City State Zip
Parent/Guardian’s preferred language of communicaon?
r English r Spanish rAmharic r Arabic rOther(pleasespecify)
LastName: FirstName: r Male rFemale
Employer:
WorkAddress:
WorkPhone:( ) - Ext:
Parent/Guardian #2:
HomePhone:( ) - CellPhone:( ) - EmailAddress:
r Father r Stepfather r Legal Guardian
r Mother rStepmother r Foster Parent
Other(pleaseindicaterelaonship):
Address: rAddressisthesameasstudent’saddressabove
Street Apt #
City State Zip
Parent/Guardian’s preferred language of communicaon?
r English r Spanish rAmharic r Arabic rOther(pleasespecify)
LastName: FirstName: r Male rFemale
Employer:
WorkAddress:
WorkPhone:( ) - Ext:
STUDENT INFORMATION
PARENT/GUARDIAN INFORMATION
Birth Cercate: r Yes rNo BirthCercate#:
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