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Student Information 2020-2021
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* Indicates required question
Email
*
Your email
Student's Legal Name: (Last)
*
Your answer
Student's Legal Name: (First)
*
Your answer
Student's Legal Name: (Middle)
*
Your answer
Student's Preferred First Name
*
Your answer
Student's Cell Phone #
*
Your answer
2020-2021 Grade Level
*
Choose
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Date of Birth:
*
MM
/
DD
/
YYYY
Gender:
*
Male
Female
Other:
Required
Name of Last School Attended:
*
Your answer
Attendance Issues? Check all that apply.
*
Yes
Frequently late to school
Anxiety
Lack of transportation
Live far from school
Medical issues
Interested in carpooling
None
Other:
Special Needs? Check all boxes that apply
*
IEP
504
SAT
BIP
ELL
ESL
NO
Other:
Required
Does your child have any medical or mental health concerns?
*
Your answer
My child will need to take medication at school.
*
No
Yes. Please email me a Medication Authorization Form for School Year 2020-2021
At this time, public schools are required by federal and state regulations to report ethnicity.
*
American Indian/Alaska Native
Asian
Black or African American
Caucasian/White
Hispanic or Latino
Native Hawaiian/other Pacific Islander
Other:
Required
Primary Residence of Student - include Street Number, Street Name and Quadrant
*
Your answer
Primary Residence of Student - Name of City
*
Albuquerque
Belen
Bernalillo
Cedar Crest
Edgewood
Los Lunas
Placitas
Rio Rancho
Santa Fe
Other:
Required
Primary Residence of Student - Zip Code
*
Your answer
Guardian #1 Name (First)
*
Your answer
Guardian # 1 Name (Last)
*
Your answer
Guardian # 1's Relationship to Student
*
Mother
Father
Other:
Required
Guardian #1's Daytime Cell Phone #
*
Your answer
Guardian #1's email Addresss
*
Your answer
Name of Guardian #1's Employer
*
Your answer
Guardian #1's Occupation
*
Your answer
Is Guardian #1 Active Military?
*
Yes
No
Is Guardian #1 a member of the National Guard
*
Yes
No
Is Guardian #1 in the Reserve
*
Yes
No
Is Place of Guardian #1's Employment located on a Government owned property?
*
Yes
No
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