(Legal name only according to birth certificate) *If no legal middle name, list NMI.
Your answer
Enter the last name of the student. *
(Legal name only according to birth certificate)
Your answer
Student Suffix *
Choose
Jr
Sr
II
III
IV
V
Not applicable
Enter the student's DATE OF BIRTH *
MM
/
DD
/
YYYY
Enter the student's social security number *
If a social security number is not available, please enter "not available".
Your answer
Enter the student's gender. *
Choose
Female
Male
Is the student Hispanic or Latino? *
Enter the race of the student. *
Choose
American Indian/Alaskan Native
Asian
Black/African American
Native Hawaiian or Other Pacific Islander
White
Enter the name of the school for which you are enrolling the student. *
Your answer
Grade level of the student for the 2020-2021 school year: *
Choose
Grade 5
Grade 6
Grade 7
Grade 8
Enter the name of the last school and district the student attended. *
Your answer
Enter the physical address of the student: *
Physical street address where student resides for which residency verification will be provided. Ex: 2100 18th Street South
Your answer
Enter the city. *
City only. Example: Birmingham
Your answer
Enter the state. *
Enter the zip code. *
If you know the zip plus four please enter all digits. Ex: 35209-1298 *If you do not know the "plus four" simply enter the five digit zip code.
Your answer
Enter the primary language the student speaks. *
Did your child receive any of the following services at his/her previous school? (Check any that apply.) *
Required
My child had a health plan on file with his/her previous school of which the nurse and teachers need to be aware. *
My child will daily or occasionally ride the bus to and/or from school and will need bus information. *
Enter the custodian/guardian first and last name. *
Please enter legal first and last name. No nicknames please.
Your answer
Enter the custodian/guardian cell phone number (area code first). *
If no cell phone, enter the number followed by "home" or "work". One phone number must be provided.
Your answer
Enter another phone number to reach the custodian/guardian followed by type. *
Ex: 205-379-2000 work *If no additional number, list n/a.
Your answer
Enter the custodian/guardian email address.
The email address provided will be used to send the registration link for the student. Please type carefully. If no email is provided, any documentation will be mailed.
Your answer
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