JEFCOED New Student Pre-Registration Form Brookville Elementary
This form must be completed for all new students to the Jefferson County School System.  This includes new Kindergarten students. All form fields must be completed unless specifically noted. Residence verification documents and new student documents must be provided directly to the school.  If you have questions, please contact Brookville Elementary @379-2700.
Sign in to Google to save your progress. Learn more
Enter the first name of the student. *
(Legal name only according to birth certificate)
Enter the middle name of the student. *
(Legal name only according to birth certificate) *If no legal middle name, list NMI.
Enter the last name of the student. *
(Legal name only according to birth certificate)
Student Suffix *
Enter the student's DATE OF BIRTH *
MM
/
DD
/
YYYY
Enter the student's social security number *
If a social security number is not available, please enter "not available".
Enter the student's gender. *
Is the student Hispanic or Latino? *
Enter the race of the student. *
Enter the name of the school for which you are enrolling the student. *
Grade level of the student for the 2020-2021 school year: *
Enter the name of the last school and district the student attended. *
If Kindergarten, list N/A.
Enter the physical address of the student: *
Physical street address where student resides for which residency verification will be provided. Ex: 2100 18th Street South
Enter the city. *
City only. Example: Birmingham
Enter the state. *
Enter the zip code. *
If you know the zip plus four please enter all digits. Ex: 35209-1298 *If you do not know the "plus four" simply enter the five digit zip code.
Enter the primary language the student speaks. *
Enter the custodian/guardian first and last name. *
Please enter legal first and last name. No nicknames please.
Enter the custodian/guardian cell phone number (area code first). *
If no cell phone, enter the number followed by "home" or "work". One phone number must be provided.
Enter another phone number to reach the custodian/guardian followed by type. *
Ex: 205-379-2000 work *If no additional number, list n/a.
Enter the custodian/guardian email address.
The email address provided will be used to send the registration link for the student. Please type carefully. If no email is provided, any documentation will be mailed.
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Jefferson County Schools. Report Abuse
Google Forms