Fillable REDLANDS UNIFIED SCHOOL DISTRICT (Redlands Unified School District)

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REDLANDS UNIFIED SCHOOL DISTRICT (Redlands Unified School District)

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REDLANDS UNIFIED SCHOOL DISTRICT
For Office Use Only:
Packet #:_____________________
Ent'd by:
ENROLLMENT DATA - Complete BOTH sides of this form
Teacher/Counselor:
ENROLLING AT:________________________________________
STUDENT'S NAME AS LEGALLY RECORDED:
Last Name First Name Gender Grade
OTHER NAME(S) STUDENT IS KNOWN BY: Student Cell Phone: Parent E-mail:
( )
RESIDENCE ADDRESS: HOME PHONE NUMBER:
( )
Number
Street, Ave, Lane, etc Apt. # City Zip Code CELL PHONE NUMBER:
MAILING ADDRESS (if different than residence address):
( )
To which number do you prefer District/
Number
Street, Ave, Lane, etc.
Apt. # City Zip Code
school notices to be sent?
Home Cell
FAMILY INFORMATION Living In
NAME HOME ADDRESS EMPLOYMENT INFORMATION the Home?
Father Employer: Yes No
Work Phone:
Mother Employer: Yes No
Work Phone:
Step- Employer: Yes No
parent
Work Phone:
Guardian Employer: Yes No
Work Phone:
Guardian's Relationship to Student:______________________________________________
Living In
Other Children in Family Birthdate Relationship School Attending
the Home?
Yes No
Yes No
Yes No
Yes No
Yes No
SCHOOL STUDENT ATTENDED LAST
( )
Name Street Address City State
Zip Code Telephone
Is student currently under an expulsion order from another district? ___Yes ___No
Expulsion Date:
School and City: Reason:
DISTRICT/SCHOOL MOBILITY
Is this the first time student is attending this school? ____Yes ____No Grade(s) attended at this school:
Has student ever attended another Redlands Unified School?____Yes ____No School Gr.
If entering from out of state, has student ever attended a California school? ____Yes ____No If yes, please continue on next line.
City: Gr.
PRIOR SPECIAL PROGRAMS
____My child is not currently participating in any special programs.
____My child is currently participating in the following special programs and/or has the following special needs (include copy of IEP):
____Adaptive P.E. ____Learning Disability
____Visually Handicapped
____Gifted/Talented Education (GATE)
(RSP, SAI, etc.) ____Special Day Class (SDC)
____Hearing Impaired ____Speech Therapy ____Form 504 Accomodations
(Include copy of 504)
Page 1 of 2
Middle Name
Name of previous California school:
CELL PHONE
ENROLLMENT DATA - Continued
ETHNICITY/RACE: The following information is for state and federal data collection purposes only. Please answer Part A and Part B.
Part A. Is this student Hispanic or Latino? (Select only one)
____ No, not Hispanic or Latino
____ Yes, Hispanic or Latino
Part A of this section is about ethnicity, not race. Regardless of your selection above, please answer the following question
by marking one or more lines to indicate what you consider the student's race to be.
Part B.
What is this student's race? (Select one or more)
____ American Indian or Alaska Native ____ Guamanian ____ Other Asian
____ Asian Indian ____ Hawaiian ____ Other Pacific Islander
____ Black or African American ____ Hmong ____ Samoan
____ Cambodian ____ Japanese ____ Tahitian
____ Chinese ____ Korean ____ Vietnamese
____ Filipino ____ Laotian ____ White
STATE TESTING DATA SURVEY - Parent Education Level
Please circle the response that describes the education level of the parent with the highest level of education:
1. Not a High School Graduate 4. College Graduate (Bachelor's Degree)
2. High School Graduate (Diploma/GED) 5. Education beyond a 4-year college degree
3. Some College (have not yet completed a 4-year program) 6. Decline to state
Who has Legal custody? Joint _____ Mother _____ Guardian _____
Who has Physical custody? Joint _____ Mother _____ Guardian _____
I certify that all of the information in this application is correct to the best of my knowledge. Falsification of any information
on this form may lead to the student being dropped from enrollment.
Date
Revised: 06/2020
avg
Page 2 of 2
IF PARENTS ARE SEPARATED OR DIVORCED, PLEASE COMPLETE THIS SECTION
Father _____
Signature of Parent/Guardian
The school has the responsibility for the welfare of the child, but can only function according to the law when properly informed.
If parents of the student are separated, the school district must be informed (1) who has custody of the student and (2) which
person(s) are approved to see the child or to transport him/her away from school. If there is a restraining order in effect denying
either of the parents the right to see or contact the child, there must be a statement on file in the school office.
Father _____
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REDLANDS UNIFIED SCHOOL DISTRICT (Redlands Unified School District)

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Completed 2 March 2022

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