Camden School System Student Information Form
Revised 02.07.19 Page 1 of 2
Date _______________________ Homeroom/Teacher - _______________________________ Grade _________
STUDENT PROPERTY ADDRESS
Pupil No. ____________________ Street ___________________________________________________________
Legal Last Name _______________________________________ Apt # ____________
Legal First Name _______________________________________ City _______________________________ State _____ Zip ______________
Preferred First Name ____________________________________ MAILING ADDRESS
Middle Name __________________________ Gender: M F Street ___________________________________________________________
Birth Date _____________________________ Apt # ____________
Proof of Age ___________________________________________ City _______________________________ State _____ Zip ______________
Home Phone __________________________ Unlisted: Y N Vehicle Make/Model _______________________________________________
Are you Hispanic or Latino? Yes No Vehicle License Number: ___________________________________________
Ethnicity: American Indian/Alaskan Native Asian Black/African American
Native Hawaiian/Other Pacific Islander White Two or more
Social Security No. ______________________________________
ADMISSION/TRANSFER INFORMATION
Admission Date ________________________ Grade ___________
Previous School/District ___________________________________ Address _________________________________________________________
Previous School/District____________________________________ Address _________________________________________________________
PARENT/GUARDIAN INFORMATION
(Documentation of legal custody must be provided if natural parents reside at different
addresses.)
Custody ______________________________ Living With _______________________________ Court Access ______________________________
1. Relationship _________________________________________ 2. Relationship _________________________________________
Last Name ____________________________________________ Last Name ____________________________________________
First Name ____________________________________________ First Name ____________________________________________
Living w/ Student: Yes No Living w/ Student: Yes No
Same as Student Address: Yes No Same as Student Address: Yes No
Address ______________________________________________ Address ______________________________________________
_____________________________________________________ _____________________________________________________
Language ________________________ Speaks English: Y N Language _______________________ Speaks English: Y N
Place of Employment ____________________________________ Place of Employment ____________________________________
Occupation ____________________________________________ Occupation ____________________________________________
Business Phone ________________________________________ Business Phone ________________________________________
Home Phone ___________________________________________ Home Phone ___________________________________________
Cell Phone/Other ________________________________________ Cell Phone/Other ________________________________________
E-Mail Address _________________________________________ E-Mail Address _________________________________________
Education Level _________________________________________ Education Level _________________________________________
