Champions for Children
Champions for Children

 

 

Bellevue Public Schools
Student Enrollment Form

 

*Required Information
STUDENT NAME
Last:*
First:*
Middle Initial:
Sex:* Female



Contact Phone*
Unlisted
Restricted


Contact Email
Grade
BIRTHDATE*
 BIRTHPLACE
 
Month/Day/Year
 State/Country
       
NAME OF SCHOOL PREVIOUSLY ATTENDED
School City State



STUDENT LIVES WITH*
Both Parents
Natural Father
Natural Mother
Guardian
Other
   
Ward of the Court:
Yes No
ETHNIC GROUP (For Required Federal Reporting - Please Check One)*
White Not Hispanic
Black Not Hispanic
American Indian / Alaskan Native
Asian / Pacific Islander
Hispanic

If English is not spoken in the home, please specify,
Language:

Anticipated HOME ADDRESS in Bellevue/Offutt:
 
Street
City
State
Zip Code
 

HEAD OF HOUSEHOLD/GUARDIAN NAME:
Last First M.I.
Employer:
Title/Rank:
Work Phone :
Cell Phone :
Pager Number :
   

SPOUSE NAME:
Last First M.I.
Employer:
Title/Rank:
Work Phone :
Cell Phone :
Pager Number :
   
Is this student currently expelled or suspended from another school district?*
Yes No

Are there legal/court restrictions affecting access to this student or his/her records?*
Yes No
If yes, please clarify:

Name of school previously attended in the Bellevue School District:

Grade Date Withdrew