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Student Enrollment Form
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* Indicates required question
Email
*
Your email
Contact Information
Your first name:
*
Your answer
Your last name:
*
Your answer
Your phone:
*
Your answer
Preferred method of contact:
*
Email
Text Message
Phone Call
Your relationship to student:
Parent/Guardian
CPS Caseworkers
Case Manager
CASA Volunteer
Other:
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Student's first name:
*
Your answer
Student's last name:
*
Your answer
Student's preferred name (if different than above):
Your answer
Student's date of birth:
*
Your answer
Student's preferred pronoun:
*
He/His
She/Her
They/Their
Other:
Student's ethnicity:
*
Asian
Black/African American
Caucasian
Hispanic/Latinx
Native American
Pacific Islander
Prefer not to answer
Other:
Student's address:
*
Your answer
Student's city:
*
Your answer
Student's state:
*
Your answer
Student's zip code:
*
Your answer
Student's county:
*
Your answer
Student's placement:
*
Private Placement
Foster Group Home
Independent Living
Living with relative/kinship
Adopted
Other:
What school district does your student attend?
*
Your answer
What grade is your student enrolled in?
*
Choose
Not Applicable
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade (Freshman)
10th Grade (Sophomore)
11th Grade (Junior)
12th Grade (Senior)
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