2018-2019 STUDENT ENROLLMENT FORM

Student First Name:

(Required)

Student Middle Name:

Student Last Name:

(Required)

Gender:

(Required)

Grade Entering:

(Required)

Birthdate:

Open the calendar popup.

(Required)

Home Phone:

Student's Cell (if applicable):

Street Address

Street:

(Required)

City:

(Required)

State:

select

(Required)

Zip:

(Required)

Mailing Address

(if different than street address)

Street:

City:

State:

select

Zip:

Siblings

List all brothers and sisters school age or younger:

Name:

Age:

Grade:

School (if attending):

Name:

Age:

Grade:

School (if attending):

Name:

Age:

Grade:

School (if attending):

Name:

Age:

Grade:

School (if attending):

Parent Information

How did you learn about El-Abbadi Charter Academy?

Has student ever attended El-Abbadi Charter Academy before?

Yes

(Required)

If yes, what years?

Last school attended:

Dates Attended:

School address

Street:

City:

State:

select

Zip:

School Phone:

Has this student been suspended or expelled from any school in the last 2 years?

Yes, Suspended

Yes, Expelled

Please note: we cannot accept students who have been expelled from another school

If yes, explain:

Has this student ever been identified as needing special education services?

Yes

(Required)

If yes, what type?

(If yes, please bring special education records with you)

If this student has ever received any of the following services, list the dates of service.

Tutoring outside school:

Speech/Language Services:

Occupational Therapy:

Remedial Reading:

Remedial Math:

Special Education:

Counseling or Psychotherapy:

Gifted Education:

Language Survey

What is the primary language used in the home, regardless of the language spoken by the student?

(Required)

What is the language spoken most often by the student?

(Required)

What is the language that the student first acquired?

(Required)

Federal Ethnicity/Race Survey

Is this student of Hispanic/Latino ethnicity?

Yes

(Required)

(A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.) Choose only one.

In accordance with Federal guidelines, the above part of the question is about ethnicity, not race. No matter what you selected above, please continue to answer the following by marking one or more boxes to indicate your child’s race.

What is this student’s race? Choose one or more.

American Indian or Alaska Native (A person having origins in the original peoples of North and South America, including Central America, and who maintains tribal affiliation or community attachment.)

Asian (A person having origins in the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.)

Black or African American (A person having origins in the black racial groups of Africa.)

Native Hawaiian or Other Pacific Islander (A person having origins in the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.)

White (A person having origins in the original peoples of Europe, the Middle East, or North Africa.)

Email:

Enter Your Email Address To Recieve A Copy Of This Form