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UM Kindergarten Registration
The person who is completing this form is the person whose email address that is being collected by this form.
One student per form.
Please answer ALL questions COMPLETELY.
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* Indicates required question
Email
*
Your email
Child's First Name
*
Your answer
Child's Middle Name
*
If child does not have a middle name - enter the word none
Your answer
Child's Last Name
*
Your answer
Surname (If applicable)
*
Jr.
III
IV
None
Other:
Child's date of birth
*
MM
/
DD
/
YYYY
Child's Gender
*
Female
Male
Other:
Child's Ethnicity
*
African Ameican
Alaskan Native/Native American Indian
Asian
Caucasion
Multi-Racial
Native Hawaiian/Pacific Islander
Hispanic?
*
Yes
No
What language is primarily spoken in your home?
*
Your answer
Child's Birth City
*
Your answer
Child's Birth State
*
Your answer
Country of Birth
*
Your answer
If born outside the US, date child entered the US
MM
/
DD
/
YYYY
Does Student have an IEP (Individualized Education Program)/Early Intervention Program?
*
Yes
No
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