RegistrationForm
School: Grade: SchoolYear:
COM1101 TucsonUnifiedSchool District Revised:01/16/2020
1010E10
th
St.,Tucson,AZ85719|Phone(520)2256400
http://www.tusd1.org
1. StudentInformation(PleasePRINTstudentnameex actlyasitappearsonthebirthcertificate )
LegalLastName: LegalFirst Name: FullMi ddl eName:
Gender:
MaleFemale
Age:
2. Language 3. DateofBirth 4. CountryofBirth
Primarylanguageusedinthehomeregardlessof
ofthelanguagespokenbythestudent?EnglishSpanishOther______________
Languagemostoftenspokenbythestudent?EnglishSpanishOther______________
Languagethatthestudentfirstacquired? EnglishSpanishOther______________
MM DD YYYY
UnitedStates
Other_____________________
USOnly‐Stateof Birth:
5. RaceandEthnicity(Checkallthatapply) 6. Student’sPRIMARYracial/ethnicidentity(chooseonlyone)
Isthisstude nt
Hispanic/Latino?
YesNo
AmericanIndi an/Alaska Native Asian
Bl ack/AfricanAmerica n White
Na tiv eHawaiian/P aci fi cIslander
Asian Multiracial
White
AmericanIndian/AlaskaNative
Black/AfricanAmerican
NativeHawaiian/Pacific
Islander
Hispanic/Latino
7. HomeAddress
ResidentialAddress: City: State: Zip: MailingAddress(ifdifferent): City: State: Zip:
8. Parents/Guardians‐MustbeLegalGuardians–EmergencyContactslistedbelow
Parent/Guardian
StudentLivesWith
Relationship:MotherFatherLegalGuardian Interpreterneeded?YesNoIfyes,whi ch language?
LastName: FirstName: HomePhone: CellPhone: WorkPhone:
Military:ActiveReserveStart Date: EndDate:
Email: Employer:
Other
Parent/Guardian
Al so LivesWithRelationship:MotherFatherLegalGuardianInterpreterneeded?YesNoIfyes,whichlanguage?
LastName:FirstName:HomePhone:CellPhone:WorkPhone:
Military:ActiveReserveStart Date: EndDate:
Address:City:State: Zip: Email:Employer:
9. Siblings
Name(lastname,firstname) DateofBirthSchool(ifattending) Grade
__________________________________________________ _____________________________________________________________
__________________________________________________ _____________________________________________________________
__________________________________________________ _____________________________________________________________
10. OtherInformation(checkallthatapply)
Foster/DCS RefugeeStatusMigrant(Agricultural orForestryIndustryDependent)TeenParent ChronicIllness
11. EmergencyContactsPersonswhowillcarefor/pickupstudentifparentcannotbereached.
(mustbe over18andshowphotoID)
Relationship:Ste p pa re n tGrandparentFriendOt h e r___________________________________
Name: HomePhone: WorkPhone: CellPhone:
Interpreterneeded?
Language
Relationship:Ste p pa re n tGrandparentFriendOt h e r___________________________________
Name: HomePhone: WorkPhone: CellPhone:
Interpreterneeded?
Language
12. EnrollmentHistory
LastSchoolAttended:_______________________________City:____________________State:______
Type:TUSDNonTUSDPublic/CharterPrivateOther__________
HasthisstudenteverattendedaTUSDschool?YesNo
Ifyes,whichschool?_________________________________
13. SpecialClasses,AccommodationsorServices(checkallthat applypastorpresent)
Engli s h Language DevelopmentGATE/Gifted/AcceleratedProgram504PlanProvidecopySpecial EducationCurrentIEPProvidecopy
Resource SelfContained SpeechTherapy Occupational/PhysicalTherapy Oth e r
14. Transportation
Studentsmustmeeteligibilityguidelin esas listedinBoardPolicyEEA(pleaseseethe TUSDwe bs ite ) .
Ifeligible,willthisstudentridethebus? YesNoIfye s,studentwillride:ToandFromSchoolToschoolonlyFromschoolonly
OfficeUse
Only
PermID#_______________SAIS/EdFiID______________NeighborhoodSchoolVerified:YesNoDateEnrolled:____________EntryCode:_______
SynergyEntryDate:______________Enteredby:__________BirthdateVerifiedby:__________BirthCertBaptismCertOther___________
Cohortverifiedby:________SpecialClasses&Accommodations (Box13)notifiedby:504___________GATE___________ELL___________ExEd___________
PictureIDProofofResidenc yImmunizationsHealthCardPHLOTEMcKinneyVentoCUMFileReviewed
Parent/GuardianSignature____________________________________________________________Date___________________________
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