Stillwater Area Public Schools

District Use
Trans Code Student #

Kindergarten Enrollment Form 2011-2012

Parent/Guardian Signature: Date:

N N N

E.O. Food Trans

Central Services Attn: Enrollment Office 1875 South Greeley Street Stillwater, MN 55082 Tel: 651-351-8412 Fax: 651 351-8370

Student Information:
First Name (legal) Middle Name (legal) Last Name (legal) Birthdate

Gender

Grade K

1. oes parent/guardian have legal custody of student? N Yes D H 2. as student completed Pre-school Screening?

N No

N Yes N No If yes, district name 3. s student receiving special education services (has an IEP)? I N Yes N No Does student require special transportation per IEP? N Yes N No
H 4. ave you moved to this district for temporary seasonal agricultural or fishing work in the last 36 months? N Yes 5. Which language did your child learn first?

Ethnicity/Race Is your student Hispanic/Latino

N Yes N No

N No

N English N Other

Please identify the race of your student by checking either Yes or No in any of the categories that apply.

(Which language?) (Which language?) (Which language?)

6. Which language is most often spoken in your home? 7. Which language does your child usually speak?

N English N Other N English N Other

N Yes N Yes N Yes N Yes

N No .....................................American Indian or Alaska Native N No ........................................................................................Asian N No ..................................................Black or African American N No .................................. Native Hawaiian or Pacific Islander N No ...................................................................................... White

Please choose one of the following options: N My student will attend the elementary school in our attendance area which is: N Afton-Lakeland N Andersen N Lake Elmo N Lily Lake N Oak Park N Rutherford N Stonebridge N Withrow N Marine N Valley Crossing

N Yes

N I would prefer my student attend a different public school within the Stillwater Area Public School Districts
boundaries. Alternate School Application must be submitted with this enrollment form. Please stop by your local elementary school or Central Services Office to obtain an Alternate School Attendance Application. Deadline for returning applications is January 15, 2011. Alternate School Choice:

List additional preschool children residing in the home

First, Middle, Last Name Birthdate Gender

N My student will not attend kindergarten until fall of 2012. N My student will be home schooled. N My student has applied to attend a public school other than District 834.
They will be attending School Name and/or District # as a (check one)

N Open Enrollment N Charter School

N My student will attend a nonpublic school.

Please print name of school and city (We are required to keep track of District 834 students enrolled in private schools.)

Parent/Guardian Residing with Student

First Name Middle Initial Last Name
Home: Cell: Work: Email Address: Home: Cell: Work: Email Address:

Phone/Email

Relationship to Student

Student lives with: (check one)

N Both Parents N Other Relative

N Mother N Alone

N Father N Spouse

N Guardian N Foster Parent

N Mother and Stepfather N Grandparent

N Father and Stepmother N Other

District 834 Address (Student)

House Number Street Name Apt. # City State Zip

Do you use a PO Box?

PO Box #

City

State

Zip

Current Address (if not in District 834)

House Number Street Name Apt. # City State Zip

Date expected to move into District:

Second Mailing (Non-Custodial Parent): List other parent/guardian for additional mailings and information
First Name Middle Initial Last Name
Home: Cell: Work: Email Address:

Phone

Relationship to Student

House Number

Street Name

Apt. #

City

State

Zip