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New Kindergarten Student Information - Armstrong
In order to gain some important, basic information about your incoming kindergartner prior to registration and screening in August, please complete the following information.
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* Indicates required question
Student Last Name
*
Your answer
Student First Name
*
Your answer
Student Middle Name
*
Your answer
Nickname
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Female
Male
Address
*
Your answer
Home Phone
*
Your answer
Place of Birth (City, State, Country)
*
Your answer
Race (Check ALL that apply)
*
1-American Indian or Alaskan Native
2-Asian
3-Black or African American
4-Native Hawaiian or other Pacific Islander
5-White
Required
Ethnicity - Is this student Hispanic/Latino?
*
Yes
No
Student Resides With:
Please complete the followng information for the parents the student resides with. There will be space to complete information for 2 adults here. Information about additional adults/non-custodial family may be entered in another section. If the student only resides with 1 adult, write "n/a" or "none" in each of those blanks.
#1 Name
*
Your answer
#1 Relationship
*
Your answer
#1 Phone
*
Your answer
#1 Employer
*
Your answer
#1 Work Phone
*
Your answer
#1 Email Address
*
Your answer
#2 Name
Your answer
#2 Relationship
Your answer
#2 Phone
Your answer
#2 Employer
Your answer
#2 Work Phone
Your answer
#2 Email Address
Your answer
Non-Custodial Family (If Applicable)
This section is not required, but please enter information about parents/step-parents that the student does not live with.
#1 Name
Your answer
#1 Relationship
Your answer
#1 Phone
Your answer
#1 Employer
Your answer
#1 Work Phone
Your answer
#1 Email Address
Your answer
#2 Name
Your answer
#2 Relationship
Your answer
#2 Phone
Your answer
#2 Employer
Your answer
#2 Work Phone
Your answer
#2 Email Address
Your answer
Emergency Contacts
Please complete the following information. These contacts should be someone other than parents or those listed above.
Emergency Contact #1 Name
*
Your answer
Emergency Contact #1 Relationship
*
Your answer
Emergency Contact #1 Phone (2 numbers if possible; label appropriately)
*
Your answer
Emergency Contact #2 Name
*
Your answer
Emergency Contact #2 Relationship
*
Your answer
Emergency Contact #2 Phone (2 numbers if possible; label appropriately)
*
Your answer
Names of Brothers and Sisters with their Date of Birth
*
Your answer
Most Recent School Attended (Name and Address of School)
*
Your answer
Has this child ever attended a school in District 86?
*
Yes
No
My child is currently receiving special education services
*
Yes
No
My child has an IEP (Individualized Education Program)
*
Yes
No
My child has a current 504 plan
*
Yes
No
My child is currently receiving speech related services
*
Yes
No
My child receives extra help in the following areas:
*
Your answer
Home Language
*
Your answer
Thank you for completing this information. Please check
www.epd86.org
as August nears for registration date and time information. Please remember to bring your incoming kindergarten student with you to registration in order for them to be screened.
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