Student Registration Form

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*Please complete this form with accurate information to ensure your success at NOTEP. Reach out to a staff member if you're unsure about any of these questions. All responses are confidential to NOTEP staff and will help us better serve you.

First and Last Name (No Nicknames) *

Social Security Number (no dashes) *

Birth City *

Birth Date *

YYYY

Phone Number (no dashes) *

Email *

You will need a personal gmail account to do some NOTEP work. Do you have a gmail account you have access to? *

Yes

No, I will need to create one

Parent / Guardian Name *

Parent / Guardian Phone *

Parent / Guardian Email *

Home Address (example of how to write your address: 6601 Franklin Avenue, New Orleans, LA 70122) *

High School Graduation Date (ex.: Spring 2020) *

High School (if not currently enrolled, type "none") *

Race *

Black or African American

Hispanic or Latino

American Indian or Alaskan Native

White (non-hispanic)

Prefer not to say

Sex *

Male

Female

Non-Binary

Prefer not to say

Are you an English Language Learner (ELL)? This means English is not your first language, and you learned English in school. *

Yes

Somewhat

Disability *

Yes

Maybe

Special Education *

504 Plan

IEP

Testing Accomodations

Unsure

None of the above

Receive Free School Lunch *

Yes

Maybe

Any additional information that will help us better serve you? (not required to submit form)

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