Step 1 - Demographics

Please verify the spelling of your child's name before moving to the next section.
The name must be as listed on the child's Birth Certificate.


Student Name

First

*

Preferred Name:

Middle:

Last:

*

Suffix:


Pertinent Student Information

Date of Birth:

*

Race:

*

Additional Races:

Gender:

*

Language Background:

*

Primary Home Type: