To be completed by the school:
I, _____________________________, _______________________ @ ______________________ ES / MS / HS
print name print title name of school
have verified the social security # by visually checking the student’s social security card.
MIS Form 41-01136 Office of Student Assignment Revised 3-2016 Expires 3/2021
Collection of Student Social Security Numbers
Section 1008.386, F.S. requires school districts to request a social security number for each student in grades
PK-Adult who enroll or are enrolled in school. However, a student is not required to provide his or her social
security number as a condition of enrollment or graduation.
1008.386 Social security numbers used as student identification numbers.—Each district school board shall request that
each student enrolled in a public school in this state provide his or her social security number. Each school district shall use
social security numbers as student identification numbers in the management information system maintained by the school
district. However, a student is not required to provide his or her social security number as a condition for enrollment or
graduation. A student satisfies this requirement by presenting to school enrollment officials his or her social security card or
a copy of the card. The school district shall include the social security number in the student’s permanent records and shall
indicate if the student identification number is not a social security number. The Commissioner of Education shall provide
assistance to school districts to assure that the assignment of student identification numbers other than social security
numbers is kept to a minimum and to avoid duplication of any student identification number.
The collected social security number may be used for all or some of the following purposes:
1. Registration and tracking of students, including State Reporting
2. Local Accountability
4. Migrant Tracking
Instructions: Please check one of the boxes below to indicate your choice, and complete the information at the
bottom of the form.
I will provide the school district with a copy of the above student’s social security card/number.
*If this information is provided, please give the parent a signed copy of this form for their records.
Student’s Social Security Number
I will not provide the school district with a copy of the above student’s social security card/number.
I cannot provide the school district with a copy of the above student’s social security card/number.
Print Student Name Student Grade
Print Parent Name Parent Signature Date
click to sign
click to edit
click to sign
click to edit