Temporary Enrollment Form - COVID-19 Closure

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This form should be completed by the legal parent/guardian of a child who needs to enroll during the state-wide COVID-19 school closure. The information listed in this form will be verified by Central Office personnel, including social workers, who will assist in providing address verification. Please note that any student enrolled during the COVID-19 closure will be enrolled as a VISITING student which provides temporary enrollment until all required documentation can be verified. During the time of temporary enrollment, the student and the parent will receive the same access and information as all currently enrolled students. Once schools reopen, we will be able to collect required documentation to complete enrollment.

Email *

What school will your child attend? You can use the link below to determine the school based on your address. Please note that Bragg Street, Floyd L Knight, Lee Early College, Tramway Elementary and Warren Williams are application-based and/or alternative settings and therefore are not eligible for open enrollment. https://www.lee.k12.nc.us/cms/lib/NC01001912/Centricity/Domain/2905/2019_2020%20Districts_3_10_20.pdf

Student's Legal Name: *

Please enter the student's legal name exactly as it appears on their birth certificate.

Student's Home Address: *

Student's Primary Phone Number *

The phone number listed here will receive automated contacts from Lee County Schools

Birthdate: *

YYYY

Gender: *

Ethnicity: *

Hispanic/Latino

Non Hispanic

Race: *

Please check all that apply.

White

Black/African American

American Indian/Alaskan Native

Asian

Hawaiian/Pacific Islander

Required

Student's Current Grade: *

Previous School Name: *

Previous School Address: *

Previous School Phone Number *

Previous School Fax Number (if available):

Has student been served in any of the following programs?

Academically Gifted

Learning Disabilities

Hearing Impaired

ESL

Speech/Language

Title 1 Reading

504

Migrant

What is the language most often spoken in your home? *

Have you or someone in your immediate family moved to seek work in agriculture, food processing or fisheries within the last three years? *

Mother's Legal Name: *

Mother's Primary Phone Number: *

Father's Legal Name: *

Father's Primary Phone Number: *

Form Completed by: *

Relationship to Student: *

Today's Date: *

YYYY

Send me a copy of my responses.

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