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PHE New Student Enrollment Form
K - 5th Grade
Fill out this form to provide us with some personal and legal information about your student that's required for public school enrollment.
* Indicates required question
STUDENT INFORMATION
First Name
(legal)
*
Your answer
Middle Name
(legal)
*
Your answer
Last Name
(legal)
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Nickname
(if applicable)
Your answer
Gender
*
Female
Male
Grade
*
Kindergarten
1st
2nd
3rd
4th
5th
Social Security Number
*
If you wish to withhold your student's SSN, you may enter N\A to request that the school district assign your child a nine-digit number designated by the Department of Education.
Your answer
Hispanic/Latino Ethnicity
*
Yes
No
Race
*
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Additional Races (check all that apply)
*
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Required
Language Spoken at Home
*
Your answer
Student Email Address
Your answer
Student Home Phone
*
Your answer
Student Cell Phone
Your answer
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