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Omni Middle School 6th Grade Elective Course Selection Form
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Personal Information
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Last Name
*
Student's Legal Last Name
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First Name
*
Student's Legal First Name
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Middle Initial
Student's Middle Initial (Optional)
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Student Number
*
If new to the School District of Palm Beach County, please enter "00123456" below
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Gender
*
Male
Female
Date of Birth
*
Please enter in the following format: MM/DD/YYYY
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Home Address
*
Please Include City, State, and Zip Code
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Parent/Guardian Name(s)
*
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Primary Phone Number
*
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Work Phone Number
*
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Cell Phone Number
*
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Parent Email Address
*
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Current or Last School (2019-2020)
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** You may only submit one course selection form **
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