School District of Augusta New Student Enrollment Form

Augusta School District New Student Enrollment Form

(Please fill in all sections with current information)
Student's Legal Name:

First NameMiddle NameLast Name
Name Suffix (if applicable)
Date of Birth:

MonthDayYear
Date
Gender
Race: Racial Identity
Race: Ethnic Identity
Please list Race Designation or Ethnic/Tribal Affiliation
Enter if any identity is selected other than White
Language:
Student Primarily Lives With (Choose all that apply):
Grade Entering:
School Student Will Attend:
Has this student ever been expelled from a school or have an abeyance agreement in lieu of expulsion?
If yes, please explain.
Has this student ever been enrolled in any type of special education program, past or present?
If yes, please explain.
HOUSEHOLD #1 INFORMATION

(Primary residence for the student)
Parent/Guardian #1:

First NameLast Name
Relationship to Student:
Primary Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Email (Parent/guardian #1):
example@example.com
Employer:
Parent/Guardian #2 (Household #1)

First NameLast Name
Relationship to Student:
Preferred Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Email (Parent/guardian #2):
example@example.com
Employer:
Household #1 Address:

Street Address

Mailing Address (If different than permanent)

CityState / Province

Postal / Zip Code

Please list all other children primarily living in Household #1:

Rows	Legal First Name	Legal Last Name	Gender	Date of Birth	Grade
Child #1
Child #2
Child #3
Child #4
Child #5

HOUSEHOLD #2 INFORMATION (If Applicable)

(Secondary address for the student)
Parent/Guardian #1:

First NameLast Name
Relationship to Student:
Preferred Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Email:
example@example.com
Employer:
Parent/Guardian #2 (Household #2):

First NameLast Name
Relationship to Student:
Preferred Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Email:
example@example.com
Employer:
Household #2 Address:

Street Address

Mailing address (If different than permanent)

CityState / Province

Postal / Zip Code

Please list all other children primarily living in Household #2:

Rows	Legal First Name	Legal Last Name	Gender	Date of Birth	Grade
Child #1
Child #2
Child #3
Child #4
Child #5

PARENTAL CUSTODY INFORMATION
It is necessary for the Augusta School District to have a copy of a court order that specifies restraints against the parental rights of the non-custodial parent. Without court documentation, the school will assume both parents may continue to exercise parental rights such as; receive reports, vist the student or the student's teacher, and pick up the student at school. Please provide the appropriate school office(s) with a copy of the court order that describes all restrictions, if applicable. All documents will be maintained as a confidential record.
Has the court issued orders that restrict the non-custodial parent?
PARENTAL MILITARY INFORMATION

(Please indicate any active military service.)
Is any parent/guardian currently on active duty in the military?
Is any parent/guardian a traditional member of the Guard or Reserve?
Is any parent/guardian a member of the Active Guard/Reserve (AGR) under Title 10 or full time National Guard?
HOME LANGUAGE SURVEY

The information on this form helps us identify students who may need help to develop the English language skills necessary for success in schools. Language testing may be necessary to determine if language supports are needed by your child. Answers will not be used for determining legal status or for immigration purposes. If your child is identified as eligible for English language services, you may decline some or all of the services offered to your child.
1. Was the first language used by this student English?
2. When at home, does this student hear or use a language other than English more than half of the time?
3. When at home, does this student hear or use a language other than English more than half of the time?
4. When interacting with their parents or guardians, does this student hear or use a language other than English more than half the time?
5. When interacting with caregivers other than parents or guardians, does this student hear or use a language other than English more than half the time?
6. When interacting with their siblings or other children in their home, does this student hear or use a language other than English more than half the time?
7. Is this student Native American, Native Alaskan, or Native Hawaiian?
8. Is this student’s language influenced by a Tribal language through a parent, grandparent, relative, or guardian?
9. Has this student recently moved from another school district where they were identified as an English Learner?
Section 2
Language(s) other than English used by the student:
Parent/Guardian preference for languanges used for school communications:
Oral:
Written:

Augusta School District New Student Enrollment Form

HOUSEHOLD #1 INFORMATION

HOUSEHOLD #2 INFORMATION (If Applicable)

PARENTAL CUSTODY INFORMATION

PARENTAL MILITARY INFORMATION

HOME LANGUAGE SURVEY

Student Enrollment Form Acknowledegment