Student’s Date of Birth: Student must be 5 years old prior to August 1, 2020 to attend kindergarten. *
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Ethnicity (Check all that apply) *
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Student’s House Number (Example: 675) *
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Student’s Street Name (Example: Franklin St, please use abbreviation Ave, Cir, Ct, Dr, Ln, Pkwy, Pl, Rd, St, Ter) *
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Apartment (Example: 1/A)
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Student’s Zip Code *
Student’s Primary Contact Number (Enter Primary Contact Number in this format: 219-531-3000) *
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Student’s Primary Contact Number Phone Type
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Name of primary contact for student *
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Relationship of primary contact for student
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Guardian 1 Last Name *
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Guardian 1 First Name *
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Guardian 1 Contact Number (Enter Number in this format: 219-531-3000) *
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Select Guardian 1 Contact Number Phone Type *
Guardian 1 Address
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Guardian 1 Email *
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Guardian 2 Last Name
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Guardian 2 First Name
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Guardian 2 Contact Number (Enter Primary Number in this format: 219-531-3000)
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Select Guardian 2 Contact Number Phone Type
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Guardian 2 Address
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Guardian 2 Email
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Has your child been evaluated or is he or she being evaluated for special education services through Porter County Educational Services (SELF) or another public agency? *
Is your child currently receiving special education services through an Individualized Education Plan (IEP) or an ISP (Individualized Services Plan)? *
List all names of siblings attending Valparaiso Community Schools
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Has your child attended preschool? *
If your child has attended preschool, what is the name of the preschool your child attended?
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If your child attended preschool, how long did your child attend preschool?
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