Washington Public Schools

High School Student Enrollment Form

Student's Legal First Name

Student's Middle Name

Student's Legal Last Name

Student's Preferred Name

Home Street Address

Apt. #

City

Zip Code

Gender

Female

Male

Date of Birth:

Student's Social Security Number

Grade Entering

Parent Email Address

Special Education:

Yes

504 Plan:

Yes

U.S. Citizen:

Yes

ESL:

Yes

If Yes, what is the Native Language:

Ethnic Group:

Caucasian

African American

Hispanic

Asian

Native American

Multi-Racial

Prefer Not To Answer

Other

Last School Attended:

Date Last Attended:

Last Grade Completed:

Student resides with:

Both Parents

Mother

Father

Other

If Other, Name and Relationship:

Legal/Custody Papers?

Yes

Mother's First Name

Mother's Last Name

Mother's Home Phone Number

Mother's Street Address

Mother's City of Residence

Mother's Cell Phone

Mother's Place of Employment

Mother's Work Phone

Father's First Name

Father's Last Name

Father's Home Phone Number

Father's Street Address

Father's City of Residence

Father's Cell Phone

Father's Place of Employment

Father's Work Phone

Guardian's First Name

Guardian's Last Name

Guardian's Home Phone Number

Guardian's Street Address

Guardian's City of Residence

Guardian's Cell Phone

Guardian's Place of Employment

Guardian's Work Phone

Emergency Contact (First Name):

Emergency Contact (Last Name):

Emergency Contact (Phone Number):

Relationship to Student:

Emergency Contact (First Name):

Emergency Contact (Last Name):

Emergency Contact (Phone Number):

Relationship to Student:

Was Your Student a Member of the Gifted and Talented Program at Their Previous School?

Yes

Is Your Student Enrolled in Oklahoma Promise?

Yes

Does Your Student Participate in any School Athletic Programs? (Football, Softball, Baseball, Basketball, Track, Boys or Girls Golf, Cross Country)

Reaquired field: No

Reaquired field: Yes

Last Math Course Taken and Passed by Student

Reaquired field: Pre-Algebra

Reaquired field: Algebra I

Reaquired field: Algebra II

Reaquired field: Geometry

Reaquired field: Trigonometry

Does Your Student Participate in Band?

Yes

City and State Where Student Was Born

Email a copy to

optional

Required Fields

WASHINGTON

Student Registration - High School 9th-12th

Enrollment Form