Creede School District

Enrollment Form

Student Information

First Name

Middle Name

Last Name

Preferred Name / Nickname

Gender

Grade

Date of Birth

Birthplace

Ethnicity

Hispanic or Latino

Not Hispanic of Latino

Race

American Indian or Alaskan Indian

Asian

Black or African American

Native Hawaiian or Other Pacific ISlander

White

If Transferring

Previous School

Previous School Address

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Previous School Phone

Previous School Fax

Primary Contact Information

Parent / Guardian Name

Relationship to Student

Cell Phone

Work Phone

Employer

Additional Information

Reaquired field: Primary Address where Student Resides

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Reaquired field: Mailing Address

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Alternate Contact Information

Name

Relationship to Student

Cell Phone

Work Phone

Employer

Additional Information

Alternate Contact

Address

City

State / Province / Region

Zipcode Min: 1 Max: 5

Country

Emergency Information

Contact Name

Relation

Phone

Physician

Physician Phone

Hospital

Additional Medical Information

Special Services

Does your child have any of the following?

IEP (Individualized Education Plan)

504 Plan (Accommodations and Services)

ALP (Advanced Learning Plan)

READ (Read to Ensure Academic Development K-3)

BIP (Behavior Intervention Plan)

Gifted Identification

None

Other

If your child has any of the above:

I have a copy of the plan/s

The previous school has a copy of the plan/s

Other

Home Language

Is there a language other than English spoken in the home?

Yes

If Yes, which language/s?

Does the student speak a language other than English?

Yes

If Yes, which language/s?

Expected Start Date

Email a copy to

optional

Required Fields