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MPHS Registration Request
Please complete this form separately for each student you wish to enroll at Middle Park High School
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* Indicates required question
Student's First Name
*
Your answer
Student's Middle Name
*
Your answer
Student's Last Name
*
Your answer
Student's Date of Birth
*
MM
/
DD
/
YYYY
Mailing Address
*
Your answer
Physical Address
*
Your answer
Student's Gender
*
Male
Female
Required
Student's Incoming Grade Level
*
Choose
9th grade
10th grade
11th grade
12th grade
Planned enrollment date
*
MM
/
DD
/
YYYY
Has the student ever been enrolled in an EGSD school at any time in the past?
*
Yes
No
If yes, which school did they last attend?
Choose
MPHS
EGMS
FVE
GES
Does your student have an IEP or 504 Plan
*
Yes
No
Parent name
*
Your answer
Parent phone #
*
Your answer
Parent email address
*
Your answer
Previous School Name
*
Your answer
Previous School Address
Your answer
Previous School Phone Number
*
Your answer
Previous School Fax/Email address
Your answer
Submit
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