Fillable Printable Student Enrollment Sample Form
Fillable Printable Student Enrollment Sample Form
Student Enrollment Sample Form
New Student Enrollment Form
Date: _________________ School: _________________________
Date: _________________ School: _________________________
All new students must provide proof of residence upon enrollment and current students must provide proof of residence annually.
Parent/Guardian Checklist of Documents:
__ BIRTH CERTIFICATE __ SOCIAL SECURITY CARD/OBJECTION __ IMMUNIZATION CERTIFICATE
__ EYE, EAR & DENTAL CERTIFICATE __ PHOTO IDENTIFICATION __ WITHDRAWAL FORM
__ REPORT CARD/TRANSCRIPT __ PROOF OF RESIDENCY** __ RESIDENCY AFFIDAVIT
__ STANDARDIZED TEST SCORES
(CRCT, EOCT, GHSGT)
**Please visit the APS website (http://www.atlanta.k12.ga.us/Page/34748) for Proof of Residency Documents
SCHOOL USE ONLY
STUDENT HOUSEHOLD NAME:
Student ID #:______________ Grade:______ Homeroom: __________ Counselor Name:________________ Advisor/Teacher:_________________
Transportation: ___ Bus #:____________ ___Walker ___ Car ___ Day Care Bus ___After-School Program
__Gifted __ Special Education __Student Support Team __ESOL ___ 504
Conditional enrollment is only available during the school year. Students pre-enrolling or enrolling before school starts are
not eligible for Conditional Enrollment.
__ 30 Day Conditional Enrollment Granted __ 7 Day Conditional Enrollment Granted Ending Date__________________
Items Needed To Complete Enrollment:
__ BIRTH CERTIFICATE __ SOCIAL SECURITY CARD __ IMMUNIZATION CERTIFICATE
__ EYE, EAR & DENTAL CERTIFICATE __ PHOTO IDENTIFICATION __ WITHDRAWAL FORM
__ REPORT CARD/TRANSCRIPT __ PROOF OF RESIDENCY __ RESIDENCY AFFIDAVIT
__ PROOF OF GUARDIANSHIP
School Records requested from______________________________________ Date:______________ Received:_____________
School Records requested from______________________________________ Date:______________ Received:_____________
____________________________________________________ Date:______________
Registration Personnel
STUDENT INFORMATION
Last
Name:
First
Name:
Middle
Name:
Suffix:
Grade: Gender: Current
Age:
Date of
Birth:
Social
Security #:
State of
Birth:
Country of
Birth:
(If not USA)
Date Entered
US:
Date Entered
US School:
Home Phone:
Student Cell Phone:
Home Address: (Street Address)
Apt #:
City: State: Zip:
Does Student Reside in Federally
Subsidized Housing?
Yes
No
Does Student have an IEP
(Special education)?
Yes
No
Is Student in ELL/ESOL Program?
Yes
No
Was/Is student in
Gifted/Challenge program?
Yes
No
Does student have a
504 Plan?
Yes
No
Was/Is student involved in the
Student Support Team?
Yes
No
Has the Family lived in another
county in the last three (3) years?
Yes
No
If yes, what is the date your family
arrived in Fulton county?
What language(s) did the student first
learn to speak?
What language(s) does the student
speak at home?
What language(s) does the student
speak most often?
What is your child’s race? (Select all that apply)
American Indian or Alaska
Native (A person having origins in any of the original peoples of
North and South America (including Central America), and who maintains a tribal affiliation or
community attachment.)
Asian
(A person having origins in any of 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 any of the Black racial groups of Africa
– includes Caribbean Islanders and other of African origin.)
Native Hawaiian or Other Pacific Islander
(A person having origins in any of the original
peoples of Hawaii, Guam, Samoa, or other Pacific Islands.)
White
(A person having origins in any of the original peoples of Europe, the Middle East, or North
Africa.)
Is your child Hispanic/Latino?
No, Not Hispanic/Latino
Yes, Hispanic/Latino (A person of
Cuban, Mexican, Puerto Rican, South
American, Central American, or other
Spanish Culture or origin, regardless of
race.
New Student Enrollment Form
Date: _________________ School: _________________________
Date: _________________ School: _________________________
Has your family moved in order to work in another city, county, or state, in the last three (3) years? ___ Yes ___No
If so, what is the date your family arrived in the city/town you reside? ________________________________________
Has anyone in your immediate family been involved in one of the following occupations, either full or part-time or temporarily during the
last three (3) years? (Check all that apply)
__ Agriculture; planting/picking vegetables or fruits such as tomatoes, squash, grapes, onions, strawberries, blueberries, etc.
__ Planting, growing, or cutting trees (pulpwood)/raking pine straw __ Processing/packing agricultural products
__ Dairy/Poultry/Livestock __ Meatpacking/Meat processing/Seafood
__ Fishing or fish farms __ Other (Please specify occupation):___________________
PREVIOUS SCHOOL EXPERIENCE
Pre-School Experience:
None
Early Head Start
GA Lottery Funded Pre K
Title 1 Funded Pre- K
Special Education 3 yr olds
Special Education 4 yr olds
Private Pre-K
Other Pre K Program
High School Experience: Please identify the year the student first (1
st
) entered ninth grade:
Attended an Atlanta Public School before?
YES Date:______________
NO
Last School Attended in Atlanta Public Schools?
Previous School Attended (if not in Atlanta Public Schools):
Previous School Address (City/State/Zip Code):
Previous School Phone #: Grade Date of Withdrawal:
Is student currently suspended or pending expulsion from this school?
No
Yes
Has student been expelled from ANY school?
No
Yes
Reason for Suspension/Expulsion:
SIBLINGS ENROLLED IN APS
Sibling Last Name:
First Name: Birth Date: Gender:
Male
Female
Name of APS School where sibling
is currently enrolled:
Grade:
Sibling Last Name:
First Name: Birth Date: Gender:
Male
Female
Name of APS School where sibling
is currently enrolled:
Grade:
Sibling Last Name:
First Name: Birth Date: Gender:
Male
Female
Name of APS School where sibling
is currently enrolled:
Grade:
Sibling Last Name:
First Name: Birth Date: Gender:
Male
Female
Name of APS School where sibling
is currently enrolled:
Grade:
PARENT / LEGAL GUARDIAN INFORMATION
Student Lives With:
Both Parents
Mother only
Father only
Legal Guardian
Foster
Parent
Grandparent
Other:______________________________
(If other than parent, LEGAL documentation is required.)
A student should generally be withdrawn by the person who enrolls them. The parent/legal guardian who enrolled the student may provide the school
with written permission accompanied by a copy of the parent/guardian’s photo identification for another person to withdraw a child.
Household Address:
Apt #:
City: State: Zip:
New Student Enrollment Form
Date: _________________ School: _________________________
Date: _________________ School: _________________________
Mother Father
Legal Guardian
Last Name: First Name:
Middle Initial:
Home Phone:
Work Phone: Parent Cell Phone: Other #:
Marital Status:
Employer: Highest Education Received: Speaks English?
YES
NO
Email Address:
Works on Federal Property?
YES
NO
Lives on Federal Property?
YES
NO
Mother Father
Legal Guardian
Last Name: First Name:
Middle Initial:
Home Phone:
Work Phone: Parent Cell Phone: Other:
Marital Status:
Employer: Highest Education Received: Speaks English?
YES
NO
Parent Email Address:
Works on Federal Property?
YES
NO
Lives on Federal Property?
YES
NO
EMERGENCY CONTACT(S)
Can student be picked
up by this person
Name:
Relationship: Contact Number(s):
YES
NO
Name:
Relationship: Contact Number(s):
YES
NO
Name:
Relationship: Contact Number(s):
YES
NO
Name:
Relationship: Contact Number(s):
YES
NO
Name:
Relationship: Contact Number(s):
YES
NO
Name:
Relationship: Contact Number(s):
YES
NO
PARENT/GUARDIAN RESIDENCY NOTICE
To be enrolled in Atlanta Public Schools, students must reside full-time in the City of Atlanta with their natural parent(s), legal
guardian(s), or legal custodian(s). For the purpose of this policy, a resident is defined as an individual who is a full-time occupant of a
dwelling located in the City of Atlanta and who, on any given school day, is likely to be at their stated address when not at work or
school. A person who owns property in the City of Atlanta, but does not reside in the City of Atlanta, is not considered a resident.
Parents are required to notify Atlanta Public Schools within fourteen (14) days if there is a change in residence.
Representatives of Atlanta Public Schools may visit the home to verify residency. A student enrolled in Atlanta Public Schools under
falsified information is illegally enrolled and will be immediately withdrawn from school. Parents and Guardians making false statements
or submitting false documentation is a violation of O.C.G.A. §16-9-2, §16-10- 20 and/or §16-10-71 of the criminal laws of the State of
Georgia and punishable by a fine of not more than $1,000.00 or by imprisonment for not less than one nor more than five years, or
both. O.C.G.A. 16-10-71.
PARENT/GUARDIAN SIGNATURES
I SWEAR or AFFIRM THAT THE INFORMATION I HAVE PROVIDED IS TRUE AND CORRECT.
_____________________________________
Parent/Legal Guardian Signature
Date:
___________________________________
Parent/Legal Guardian Signature
Date:
