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ORANGE COUNTY PUBLIC SCHOOLS
SCHOOL ENROLLMENT INFORMATION
To register your student in school, the
following documentation is necessary:
*The School Board of Orange County, Florida is authorized to collect social security numbers (“SSN”) of students as set forth in Sections 1008.386 and 119.071 (5)
(a) 6, Florida Statutes. The provision of a student’s SSN on the enrollment form is optional and is not required as a condition for enrollment within the District.
Any SSN provided in connection with enrollment will only be used for research, reporting and recording purposes. The collection of the SSN shall not be used for
immigration enforcement. Providing the student’s SSN to the School Board of Orange County, Florida for these purposes means that you consent to the use
of the student’s SSN in the manner described.
Verification of Legal Name
• Birth Certificate
Verification of Age* (with one of the following):
• Birth Certificate
• Passport
To enter Kindergarten, a child must be 5 years old on or before Sept. 1.
To enter first grade, a child must be 6 years old on or before Sept. 1 and successfully completed Kindergarten.
Verification of Immunization and Physical Exam
• Proof of immunizations on a Form 680, which can be obtained at the Oran
ge County
Health Department; 832 W. Central Blvd., Orlando, Fl.
• Proof of physical examination by a U.S. doctor within a year of enrollment (first day
of entry at school).
Verification of Academic History
• Transcript
• Withdrawal Form
• Last report card
Verification of Special education information (if applicable)
• Current IEP
• Current 504 plan
Verification of your residence in Orange County (with one of the following):
• Current Homestead Exemption Card, current property tax statement or signed Settlement Statement
• Current signed lease (Additional documentation could be requested)
• Verification of address: Online requirements and secure submission at:
https://www.ocps.net/departments/student_enrollment/verification_of_residence
The Office of Student Enrollment is located at 6501 Magic Way, Bldg 100-B, Orlando, FL 32809
Verification of Guardianship
• Birth Certificate
If applicable, you must provide one of the following:
• Court Documentation (such as divorce decrees w/parenting plan or the placement of children though court)
• OCPS Educational Guardianship (given only when the parent/guardian lives outside of Orange County or adjacent
counties of Brevard, Osceola, Polk, Lake, Seminole and Volusia) available at:
https://www.ocps.net/departments/student_enrollment/guardianship
The Office of Student Enrollment is located at: 6501 Magic Way, Bldg 100-B, Orlando, FL 32809
*Other forms of age verification are permissible under Section 1003.21, Florida Statues
Temporary Documentation Exemption: Students who lack a fixed, regular and adequate nighttime residence, have a right
to immediate enrollment under the McKinney-Vento Homeless Assistance Act 42 U.S.C. 11435. A completed Student
Residency Questionnaire is needed to determine eligibility (page 7-8). The student residency questionnaire is two pages.
1
OCPS Stu (Revised 01 12 2021) OCPS0486Pup
All date and Signature fields are disabled. They have to be filled in at time of Registration.
Reset Form
ORANGE COUNTY PUBLIC SCHOOLS
Student Number: ______________________________
School: ____________________________________
Student Alias # ______________________________
Orlando, F
lorida
Student Registr ation Fo rm
School Year 2021-2022
Date Received: Grade:
_______________________
In Orange County public school before Yes No
STUDENT INFORMATION
Last Name (Legal) Name Suffix
(i.e.: JR, II)
First Name (Legal) Middle Name Preferred Name Student SSN # (optional)
Domicile Address Apt # City Zip Code
Primary Phone Number
Mailing Address City
Zip Code
Parent/Guardian - Primary E-mail Address
Gender Federal Ethnic Category Federal Race Categories
(Check all applicable)
Do you need communication sent home
in a language other than English?
Student Lives With
(check all that apply)
Male
Female
Non-Hispanic/Non-Latino
Hispanic/Latino
White Black or African American
Asian American Indian/Alaska Native
Native Hawaiian or other Pacific Islanders
No Spanish Haitian Creole
Yes French
Vietnamese
Portuguese
Both Parents
Mother
Father
OCPS Ed. Guardian
Legal Guardian
Other / Step Parent
OTHER SCHOOL AGE CHILDREN LIVING AT HOME
Child’s Name (First & Last) Relation to Student School Gr. Child’s Name (First & Last) Relation to Student School Gr.
1. 2.
3. 4.
5. 6.
Domicile is defined as the place where parents/guardians have their true and fixed, permanent home and to which they have, whenever absent, the intention of returning.
The parent/guardian's domicile determines the student's domicile. Common indicators of domicile are home ownership or in the absence of home ownership a residential lease.
837.06 False official statements.—Whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her
official duty shall be guilty of a misdemeanor of the second degree, punishable as provided in s. 775.082 or s. 775.083.
This is to certify that all the information on this registration form is true to the best of my knowledge and belief. I understand that inadequate information may result in delayed entry.
Falsification of information will forfeit student's athletic and extracurricular eligibility for one (1) calendar year from the date of discovery of the violation.
______________________________________________________
Parent/Guardian Signature Date Relationship to Student
______________________________________________________
Parent/Guardian Signature Date Relationship to Student
Birth Date (Month/Day/Year)
NoYes
2
Do you have wireless Internet service at home?
If yes, is your wireless service reliable enough to support all students in your home being online simultaneously
without slowness when loading web pages or dropping the connection?
The student is a twin, triplet, etc.
Birthplace (City/State/Country)
Yes No
Yes
No
Please choose grade level
Student Name: __________________________________ Student Number: __________________________________
ADDITIONAL STUDENT INFORMATION: If the answer is"yes" to any of these question, the student will be tested for English Proficiency.
1. Language:
Is a language other than English spoken at home?
No Yes What language? ___________________________________
2. Native Language:
Did the student have a first language other than English?
No Yes What language? ___________________________________
3. Language at Home:
Does the student most frequently speak a language other than English?
No Yes What language? ___________________________________
4
. Born outside United States - If NO enter N/A
Date 1st entered U.S. school:
1. Identified as a special education student or has an active IEP ? No Yes
6. Has student ever been arrested, resulting in a charge? No Yes
2. Does student have a current 504? No Yes
3. Has student ever received a McKay scholarship? No Yes
7. Has student ever had Juvenile Justice action taken against him/her?
No
Yes
5. Has student ever been expelled from a previous School? Yes
If yes, Date:
_____________ School (Name/County/State): ______________________________
8. Has student ever been referred to mental health services?
If yes, Date:_____________
No
Yes
9
. Is
the student a parent?
No Yes
MILITARY FAMILY STUDENT SURVEY
No Parent is an active duty member of the uniformed services, including members of the National Guard and Reserve on active-duty orders
No
Yes
Parent is a member or veteran of the uniformed services who is severely injured and medically discharged or retired for a period of 1 year after medical discharge or retirement
No
Yes
Parent died as an active duty member of the uniformed services or within one year of injury.
LAST THREE SCHOOLS ATTENDED (Begin with the most recent – For Kindergarten registration – please, list Pre-K)
Type of School
Name of School
City, State
Years Attended
Grade
1. Public Home Education Private
2. Public Home Education Private
3. Public Home Education Private
1ST TIME KINDERGARTEN STUDENTS
Program Participation Prior to Kindergarten
(V) Voluntary Prekindergarten (VPK) at a Public School Name: _________________________________________________________
(P) Prekindergarten Provider (VPK) at Private School Provider Name: _________________________________________________________
(D) Prekindergarten Program (VE-PK) for children with Disabilities Name: _________________________________________________________
(H) Head Start Name: _________________________________ (N) None
10.
Is
the Parent/Guardian a mig
ratory agriculture/dair
y/fishing worker
and traveled to seek/obtain this type of work within the past 3 years?
______________________________
_______________________________________________________
3
OCPS Stu (Revised 01 12 2021) OCPS0486Pup
Pursuant to Section 1006.07, Florida Statutes, OCPS is required to ask questions 5-8 below.
Yes
4. Has student ever received a Family Empowerment scholarship?
No
No
Yes
Yes
No
Yes
ORANGE COUNTY PUBLIC SCHOOLS
Orlando, Florida
Student Contact Information
Student Name: Student Number: _____________________________
PARENT/GUARDIAN INFORMATION (Please list parent/guardian in order of contact priority.)
Last Name (Legal) First Name (Legal) Middle Name
Business Phone
Domicile Address Apt # City Zip Code Primary Phone Number Cell Phone
Parent/Guardian - Primary E-mail Address
Pickup student?
Parent/Guardian Relation to Student
Parent
Legal Guardian
Other
Guardian Ad Litem
OCPS Ed. Guardian/
Surrogate Parent
Mother
Father
Legal Guardian
Stepmother
Stepfather
Grandmother
Grandfather
Brother
Sister
Aunt
Uncle
Cousin
OCPS Ed. Guardian
Other
Last Name (Legal)
First Name (Legal) Middle Name
Domicile Address Apt # City Zip Code Cell Phone
Primary E-mail Address
Pickup student?
Legal Documentation(example: custody, restraining order, etc.)
If there is no Legal Alert: Enter "N/A" Please provide supporting documentation
Parent/Guardian Relation to Student
Parent
Legal Guardian
Other
Guardian Ad Litem
OCPS Ed. Guardian/
Surrogate Parent
Mother
Father
Legal Guardian
Stepmother
Stepfather
Grandmother
Grandfather
Brother
Sister
Aunt
Uncle
Cousin
OCPS Ed. Guardian
Other
OTHER CONTACT - Relationship __________________________________
Last Name
First Name
Contact Phone
Pickup student? Pickup student?
Yes
No
837.06 False official statements.—Whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty
shall be guilty of a misdemeanor of the second degree, punishable as provided in s. 775.082 or s. 775.083.
This is to certify that all the information on this registration form is true to the best of my knowledge and belief. I understand that inadequate information may result in delayed entry.
Falsification of information will forfeit student's athletic and extracurricular eligibility for one (1) calendar year from the date of discovery of the violation.
Parent/Guardian Signature Date Relationship to student
Parent/Guardian Signature Date
Relationship to student
Yes
No
Yes
No
______________________________________________________
______________________________________________________
Work Phone
Business Phone
Work Phone
Home Phone
Legal Documentation (example: custody, restraining order, etc.)
If there is no Legal Alert: Enter "N/A" Please provide supporting documentation
4
OCPS Stu (Revised 01 12 2021) OCPS0486Pup
Emergency Information - English
Student Number: ____________________
STUDENT INFORMATION
Medicine Currently Taking (Prescription and Over-the-Counter (OTC)
Medical History/Physical Limitations
Allergies to Medication, Food, or o
ther substances..
PARENT/GUARDIAN INFORMATION (Please list parent/guardian in order of contact priority.)
Last Name
First Name
Relationship
Pick up
Yes No
Domicile Address
Apt #
City
Zip Code
Primary Phone
Cell Phone
Employer
Business Phone
Last Name
First Name
Relationship
Pick up
Yes No
Domicile Address
Apt #
City
Zip Code
Home Phone
Cell Phone
Employer
Business Phone
Last Name (Legal) Name Suffix
(i.e. Jr., II)
First Name (Legal) Middle Name (Legal)
Preferred Name
Legal Documentation (example: custody, restraining order, etc.)
If there is no Legal Alert: Enter "N/A" Please provide supporting documentation
Gender
Birth Date
Primary Phone
Male Female
Parent/Guardian - Primary E-mail Address
Address Domicile
Address**
Apt #
City
Zip Code
Mailing Address Apt # City Zip Code
Do you need communication in a language other than English?
No Yes Spanish French Portuguese Haitian Creole Vietnamese
ORANGE COUNTY PUBLIC SCHOOLS
Orlando, Florida
Emergency and Student Health Information Form
School Year 2021-2022
5
OCPS Stu (Revised 01 12 2021) OCPS0486Pup
Medications
Other substances
Food
ADDITIONAL CONTACTS ON THE NEXT PAGE
**Proof of address must be presented to the school Registration Office in order for the address to be officially changed in the system.
*Diet Order Form - Parent/Guardians must complete and sign the front of the form in its entirety. A signature releasing medical information is necessary
should the physician need to be contacted regarding diets related to medical disabilities.
Student Name: Student Number:
ADDITIONAL CONTACTS
Last Name
First Name
Relationship
Contact Phone
Custody
Pick up
Yes No
Yes
No
Yes No
Yes
No
Yes No
Yes
No
Yes No
Yes
No
Yes No
Yes
No
SCHOOL HEALTH SERVICES
I
hereby g
ive my
consent
for this
child
to
participate in
the School Health
Services
Program.
My
child
will
receive emergency care in school, and
health appraisals including vision, hearing, growth and development.
If, upon administering a vision screening through the school or any other OCPS program, my child is determined to have a need for a follow-up
vision examination and if my child is eligible or otherwise financially qualified, I hereby authorize for OCPS or a designated third party to provide
a no-cost comprehensive vision examination by a licensed optometrist which may include dilation, refraction, and glasses if prescribed.
In the event of an EMERGENCY, I understand that the school will access the 911 emergency medical system immediately. To expedite care, I
give my permission for school personnel to provide
medical information to the responding emergency team to initiate treatment and transport to
an appropriate facility. I give my permission to first responders, medical personnel, and staff to initiate treatment immediately upon arrival. I
request to be notified of my child’s condition and admission as soon as possible. If I cannot be reached, I request that the admitting facility
notify one of the other persons listed above of my child’s condition and admission. I agree to be financially responsible for my child’s total
treatment and transport.
Parent/Guardian:
Date:
For child with IEP or receiving ESE related services, I authorize the School Board of Orange County, Florida
to release and exchange my child’s confidential information to agencies of the State of Florida which would
allow Orange County Public Schools to verify Medicaid eligibility, bill Medicaid for reimbursable Certified
School Match services reference on my child’s IEP and receive Medicaid reimbursement for Exceptional
Student Education (ESE) services it provides to my child while at school. I understand that my child will
continue to receive services referenced on his/her IEP whether or not I give consent. Please take the student's
Social
Security card to the school Registrar to finalize
authorization.
*The School Board of Orange County, Florida is authorized to collect social security numbers (“SSN”) of students as set forth in Sections 1008.386 and
119.071(5)(a)6, Florida Statutes.The provision of a student’s SSN on the enrollment form is optional and is not required as a condition for enrollment within the District.
Any SSN provided in connection with enrollment will only be used for research, reporting and recording purposes. The collection of the SSN shall not be used for
immigration enforcement. Providing the student’s SSN to the School Board of Orange County
, Florida for these purposes means that you consent to the use of the
student’s SSN in the manner described.
Florida Statute §837.06 provides that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his official
duty shall be guilty of a misdemeanor of the second degree.
(This form is effective until the first day of next school year or one year from the date signed, whichever is later)
6
OCPS Stu (Revised 01 12 2021) OCPS0486Pup
In the event of an incident or emergency and I cannot be reached, I consent and request additional contacts listed above be notified of my child’s
condition and/or of emergency medical services response to the incident.
By signing this form, I accept and acknowledge the terms herein.
2021-2022 Student Residency Questionnaire
The answers to this housing questionnaire help in determining eligibility of services that may be provided through the federal McKinney-Vento
Act, 42 U.S.C 11435. For more information, contact the OCPS MVP office at 407-317- 3485 or visit the website at www.homeless.ocps.net.
Where are you and your family currently staying at night? (only check one box):
Rent or own my own house, condo, apartment or other permanent residence. (If you checked this box, you DO NOT
need to complete the rest of this questionnaire.)
Living with someone else by choice in a house or apartment that properly accommodates all residents (if you checked
this box, you DO NOT need to complete the rest of this questionnaire).
Staying somewhere temporarily (if you checked this box, please complete the rest of this questionnaire).
FAMILY INFORMATION – PLEASE NOTE ALL SECTIONS MUST BE COMPLETED
Name of Parent(s)/Legal Guardian(s):
Current Student Nighttime
Street Address
City/ Zip
Code
How long have your been
at this address?
Please list ALL students within the family, (including pre-K children) enrolling at ANY OCPS school.
Student Name
Student ID#
M/F
DOB
Grade
School
TEMPORARY LIVING SITUATION INFORMATION – PLEASE NOTE ALL SECTIONS MUST BE COMPLETED
Check only ONE box that applies to your situation:
We are temporarily staying with another family member or friend
We are staying in a motel or hotel
We are sleeping in a vehicle or staying in a trailer park or campground, or in an abandoned building, or other substandard housing
We are staying in an emergency or transitional shelter
If the above do not apply, describe where the student most recently spent the night: ____________________________
_________________________________________________________________________________________________
Check only ONE box that applies to the cause of your temporary living situation:
Economic hardship due to COVID pandemic (illness, loss of job, etc.) that resulted in loss of housing
Economic hardship or other circumstances (NOT Related to COVID pandemic) that resulted in foreclosure, eviction, or inability to
obtain a residence at this time
Lost our housing due to a Natural Disaster (hurricane, flood, fire, etc.) and have no place else to go. Please indicate the Natural
Disaster type here: ________________________________________________
Lost our housing due to a Manmade Disaster (mold, poison gas release, domestic violence, etc.) and have no place else to go
Recently moved to the area and are looking for a place to buy or rent
Recently sold residence or lease ended and looking for a place to buy or rent
Repairing or remodeling current residence
If the above do not apply, describe the cause of your temporary living situation:
_______________________________________________________________________________________________
Please continue residency questionnaire on the next page
OCPS Stu (Revised 01 12 2021) OCPS0486Pup
7
Please choose grade level
2021-2022 Student Residency Questionnaire
The enrolling student(s) is/are:
Staying with a parent or legal guardian
Not staying with a parent or legal guardian, but staying with an adult that is not a parent or legal guardian
If you checked this box, please complete the following:
Caregiver Name: __________________________________________________________
Relationship to Student: ____________________________________________________
Phone Number: _____________________________
Not staying with a parent or legal guardian and not staying with an adult who is acting as the student’s parent
as defined in s. 1000.21(5), Florida Statutes.
If you checked this box, how long has the student been living alone? ________________________________
Other (explain): ___________________________________________________________________________
_________________________________________________________________________________________
ADDITIONAL RESOURCES INFORMATION RELEASE
Release of information to social service agencies:
Additional protective rights and services may be available
to qualified families. These rights include immediate school
enrollment, free meals, school stability, and transportation
to the school of origin. Please check ‘yes’ if you allow this
information to be released to social service agencies for
possible assistance. Release of information expires on
6/30/2021.
Yes
No
Release of information to community organizations:
Local homeless resources provided by community agencies
not governed by Orange County Public Schools may be
available to qualified families, this includes housing
assistance. Please check ‘yes’ if you allow this information
to be released to community agencies, including
registration in the Homeless Management Information
System (HMIS), and allow community agencies to contact
you about potential supports.
Yes
No
VERIFICATION OF INFORMATION
The undersigned certifies that the information provided is accurate.
Please note that Florida Statutes 837.06 provides that whoever knowingly makes a false statement in writing with
the intent to mislead a public servant in the performance of his official duty shall be guilty of a misdemeanor of the
second degree.
For additional questions regarding the OCPS McKinney-Vento Program including district policies and local resources,
please visit our website at homeless.ocps.net.
____________________________________________________________ _____________
Signature of Parent/Legal Guardian OR Unaccompanied Homeless Youth Date
FOR OCPS STAFF ONLY
If it is determined that this student is eligible for McKinney-Vento Program services, please scan this
Student Residency Questionnaire (SRQ) and email it to the following:
District MVP Office – MVPSRQ@ocps.net
School Food Service Manager
School-based McKinney-Vento Coordinator
All schools are required to keep a file (digital or paper) of all SRQs submitted.
OCPS Stu (Revised 01 12 2021) OCPS0486Pup
8
ORANGE COUNTY PUBLIC SCHOOLS
Authorization for Release of Information
School Year 2021-2022
Date: Student Number: ___________________________
To Whom It May Concern:
The following student has enrolled at our school. Please send all records including grades, courses taken, test scores, special
education, psychological data, current individualized educati
on plan (IEP), health records and immunization dates. Also, please
include all grades earned this school year and
/or withdrawal grades, if any.
Identifying Information
Student’s Name
____________ ________________ _______________
First Midd le Last
Date of Birth
________________
Parent(s)/Guardian(s) Name
_____________________________________________________
Phone #
________________
Name of Last School Attended
________________________________________________________________________________
Complete Mailing Address of Last School Attended
_________________ ______________ ______ ________
Street City State Zip
____________________________ ________________________
Phone# Fax#
Send Requested Records To
`
Parent/Guardian Signature Date:
Principal or Records Clerk
Prior written consent of the parent or guardian of the student is not required to transfer records to schools in which the pupil or student seeks or
intends to enroll.
1st request
2nd request
3rd request
9
OCPS Stu (Revised 01 12 2021) OCPS0486Pup
The School Board of Orange County, Florida, does not discriminate in admission or access to, or treatment or employment in its programs and activities, on the basis of race, color, religion, age, sex, national origin, marital
status, disability, genetic information or any other reason prohibited by law. The following individuals at the Ronald Blocker Educational Leadership Center, 445 W. Amelia Street, Orlando, Florida 32801, attend to
compliance matters: ADA Coordinator & Equal Employment Opportunity (EEO) Supervisor: Carianne Reggio; Section 504 Coordinator: Beverly Knestrick; Title IX Coordinator: Gary Preisser. (407.317.3200)
2021-2022 High School Student
Extra Curricular Activities Questionnaire
OCPS DISTRIBUTION
Student Name: __________________________________
Student Number: ______________________________
1. Athletic Director
2. Band/Orchestra/Choir Director
3. JROTC Commandant
Does the enrolling student intend to participate in extracurricular activities?
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7KLVZLOODOORZWKHVFKRROWRSURSHUO\FRQQHFW\RXWRWKHDSSURSULDWHVWDII
Fall Sports:
Winter Sports:
Spring Sports:
Performing Arts:
JROTC Program
Bowling
Cheerleading (spirit)
Cross Country
Football
Golf
Swimming & Diving
Girls Volleyball
Basketball
Competitive Cheerleading
Soccer
Girls Weightlifting
Wrestling
Baseball
Flag Football
Lacrosse
Softball
Tennis
Track & Field
Boys Volleyball
Water Polo
Boys Weightlifting
Beach Volleyball
Band / Marching Band
Orchestra
Chorus
Drama
10
OCPS Stu (Revised 01 12 2021) OCPS0486Pup
White: ESOL Portfolio
Yellow: Parent An Equal Opportunity Agency
(Rev. 01 12 2021)
OCPS0284Mul
MULTILINGUAL STUDENT EDUCATION SERVICES
English for Speakers of Other Languages (ESOL)
PARENT’S RIGHTS LETTER
FLORIDA’S COMMITMENT TO ALL ENGLISH LANGUAGE LEARNERS
All schools in Florida are committed to providing a quality educational program for all students. Public schools in
Florida must ensure that students whose heritage/home language is other than English have equal access to all
programs and services and are provided with comprehensible instruction. The following activities should take place
during this enrollment, assessment and placement process.
Home Language Survey: At the time of enrollment, all
students (parent/guardian) must respond to a home
language survey. This is done so that your child is placed in the most appropriate educational program to ensure
academic success and to comply with Florida State Law. (Section 233.058, 228.093, FS, Section I, 1990 LULAC et.
al .vs. State Board of Education Consent Decree, and Rules 6A-6.0901 and 6A-6.0902, F.A.C.)
Language Assessment: If the survey indicates that a language other than English is spoken at the home, the
student will be assessed to determine his/her level of English language proficiency and determine an appropriate
educational program. If you marked yes to more than one question on the Home Language Survey, your child
will be temporarily placed in an English Language Learner’s (ELL) Program pending language proficiency
testing.
Instructional Program Placement: Based on the language assessment results, students must be provided with
comprehensible instruction and be placed in an appropriate educational program. Each district will provide a range
of services based on the specific program implementation at the school.
Parent Notification: Parents must receive letters, notifications, and school information in a language they
understand, unless clearly not feasible, to ensure informed parent consent and meaningful access to the
educational program. As soon as the language proficiency test results are received, you will be notified as to
whether or not your child will remain in the ELL Program. Final student placement must be determined within 30
days of entry in school.
Parent Leadership Council: Each district must provide parent advisory meetings so parents have an opportunity to
participate in the educational program development process.
Exit Criteria: Students will exit ESOL services when they meet the established State exit criteria in English to
determine proficiency in listening, speaking, reading, and writing. Students are assessed annually in English to
determine progress and/or readiness to be exited from the program.
_________________________________ _________________________
Parent/Guardian Signature Date
Student Name: Student ID#: Date: Grade:
School: Date Entered US School: Original Entry Date:
11
1. Language:
Does the student most frequently speak a language other than English?
No
Yes
What language? ______________
_
_
___________________
3. Language at Home:
Is a language other than English spoken at home?
No
Yes
What language? ___________________________________
2. Native Language:
Did the student have a first language other than English?
No
Yes
What language? ________________________________
4. Born outside United States - If NO enter N/A
_______________________________________________________
5. Previous Schools:
Name of School
City, State
Years Attended
Grade
Please choose grade level
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Completed 15 March 2021

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