KEES New Student Registration
This form is for students who are enrolling in our district for the first time.
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Email *
Student's Full (Legal) Name *
Has the student ever attended a school in Williston and Blackville? *
DOB *
MM
/
DD
/
YYYY
Gender *
Race (Check all that apply) *
Required
Grade Level *
City and State of Birth *
Physical Address *
Mailing Address (If different)
Primary phone number for contact *
Has the student previously attended KE? *
If yes, when?
Who does the student live with? *
Coming to KE from what school? (Please include city and state) *
Does the student have any of the following medical issues?
Does the student take any medication? (Please list)
If the student does take medication, does the nurse need to administer?
Clear selection
Does the student have an IEP or 504? *
Has the student been identified as Gifted and Talented? *
Has the student ever been expelled from school? *
Has the student ever repeated a grade? *
If yes, when?
Is the student a bus rider? *
If the student is in Kindergarten: Did he/she attend a 4-year-old program?
Clear selection
If yes, where?
If the student is in 4K or 5K: Was he/she less than 5.5 pounds at birth?
Clear selection
Does the student meet any of the following three definitions of "homeless"? 1) Temporarily sharing housing with others due to economic or other hardship 2) Living in hotel, motel, campground, or shelter 3) Sleeping in car, park, public space, or similar setting *
Name of insurance provider
Policy Number
In the last 3 years, has the student experienced any serious injuries, illnesses more than a week, or hospitalizations? *
If yes, please explain:
What is the language that the student first acquired? *
What language is spoken most often by the student *
What is the primary language used in the home, regardless of the language spoken by the student? *
In what language do you wish to have communication from the school? *
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