Student Information
Legal Name from Birth Certificate
**First Name: Middle: **Last:
**Date of Birth: MM/DD/YYYY
**Gender:
Preferred First Name:
**School:
**Previous School:
Enter NONE in all three boxes
if Kindergarten student
School Name:
City:
State:
**Next Year's Grade Level:
**Anticipated Start Date:
Current Special Programs IEP 504 ELL Speech Therapy
Guardian Information
**First Name: **Last Name:
**Relationship to Student:
Other Students in Family: Check this box if other members of your family are active students at our schools
**Desired User Name: Desired User Name for PowerSchool Login
**Email:
**Phone: 999-999-9999      Alternate Phone: 999-999-9999
**Street:
**City:
**State:
**Zip Code:
**Verification: I verify that the above information is correct
** Required Information