Alexandria Public Schools Census Form

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Make sure you're on the list to include important district information! Complete this form for all children who are not yet in elementary school from 0-5 years old. This will ensure you receive timely district registration and event information.

Child's Full Name (First, Middle, Last) *

Child's Date of Birth *

YYYY

Gender *

Male

Female

Race and Ethnicity
*

American Indian/Alaskan

Asian/Pacific Islander

Hispanic

Black, not Hispanic

White, not Hispanic

Native Hawaiian or Other Pacific Islander

Child Resides With *

Both parents

Mother

Father

Other family (grandparents)

Foster parents

Other:

Parent/Guardian Contact 1 (First, Middle, Last) *

Contact 1 Phone *

Contact 1 Email Address *

Contact 1 Physical Address *

Parent/Guardian Contact 2 (First, Middle, Last)

Contact 2 Phone

Contact 2 Email Address

Contact 2 Physical Address (if different from above)

Interpreter needed *

Yes

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