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*

MaleFemale
Race: Racial Identity*

American Indian/Alaskan NativeAsianBlack or African AmericanNative Hawaiian or other Pacific IslanderWhite
Race: Ethnic Identity*

Hispanic or LatinoNot Hispanic or Latino
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):*

MotherFatherStep-MotherStep-FatherFoster ParentGuardianOther
Grade Entering:*
School Student Will Attend:*

Speech Only4KElementary School (Grades K-5)Middle School (Grades 6-8)High School (Grades 9-12)Wildlands Research School
Has this student ever been expelled from a school or have an abeyance agreement in lieu of expulsion?*

YesNo
If yes, please explain.
Has this student ever been enrolled in any type of special education program, past or present?*

YesNo
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.
Work Phone Number:
Please enter a valid phone number.
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.
Work Phone Number:
Please enter a valid phone number.
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:

	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.
Work Phone Number:
Please enter a valid phone number.
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.
Work Phone Number:
Please enter a valid phone number.
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:

	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?*

YesNo
PARENTAL MILITARY INFORMATION

(Please indicate any active military service.)
Is any parent/guardian currently on active duty in the military?*

YesNo
Is any parent/guardian a traditional member of the Guard or Reserve?*

YesNo
Is any parent/guardian a member of the Active Guard/Reserve (AGR) under Title 10 or full time National Guard?*

YesNo
HOME LANGUAGE SURVEY

In order to comply with state requirements and to assist the Augusta School District in communicating with those at home, please answer the following questions about your child's home language. This is for school purposes only.
What language(s) did your child speak when he/she first began to talk?*

EnglishOther
What language(s) does your child currently speak at home?*

EnglishOther
What language(s) does your child speak with their friends?*

EnglishOther
What language(s) do you or other parent/guardians use when speaking to your child?*

EnglishOther
Is there an adult in your home who can read English?*

YesNo
Do you need a translator available at school?*

YesNo

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