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Levittown Public Schools: New Student Intake Form 2021-22
Please fill out the fields below for registration of students in Levittown Public Schools. Please fill out one Intake Form for each child.
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* Indicates required question
Email
*
Your email
Student First Name
*
Your answer
Student Last Name
*
Your answer
Grade
*
Choose
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10 Grade
11th Grade
12th Grade
Student's Birthdate
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Other
Would you prefer the Registration packet sent via email or mailed to current address?
*
Email
Current Address
Other:
Parent/ Guardian 1's Name (Last, First)
*
Your answer
Parent/ Guardian 1's Cell
*
Your answer
Parent/ Guardian 1's email address
Your answer
Parent/ Guardian 2's Name (Last, First)
*
Your answer
Parent/ Guardian 2's Cell
*
Your answer
Parent/ Guardian 2's email address
Your answer
Current Address (Street)
*
Your answer
Current Town
*
Your answer
Current Zip Code
*
Your answer
Current School Name
*
Your answer
Current School Address
*
Your answer
Current School Phone Number
*
Your answer
Current School Fax Number
*
Your answer
Moving To: NEW ADDRESS Street
*
Your answer
Moving To: NEW ADDRESS Town
Your answer
Moving To: NEW ADDRESS Zip Code
Your answer
New residence?
*
Own
Rent
Received ENL Services
*
Yes
No
Receives Special Education Services
*
Yes
No
Child has an IEP
*
Yes
No
Child has a 504
*
Yes
No
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