Alva Public Schools

Washington Information sheet

Enrollment Date

Distance from home to school (Miles)

Have you ever attended Alva Schools before:

Reaquired field: Yes

Reaquired field: No

Grade Entering

Child's Legal First Name

Child's Middle Name

Child's Legal Last Name

Child's Preferred Name

Date of Birth:

Place of Birth

Age

Gender

Reaquired field: Female

Reaquired field: Male

Social Security ( Optional)

Home Street Address

Apt. #

City

Zip Code

Ethnic Group:

Reaquired field: (01)Black/African American

Reaquired field: (02)American Indian /Alaska Native

Reaquired field: (04) Asian

Reaquired field: (05) Native Hawaiian/Other Islander

Reaquired field: (06) White/ Caucasian

Reaquired field: Multi-Racial

Ethnicity Is the student Hispanic/ Latino

Reaquired field: YES

Reaquired field: NO

Special Education:

Reaquired field: No

Reaquired field: Yes

504 Plan:

Yes

U.S. Citizen:

Reaquired field: No

Reaquired field: Yes

ESL:

Yes

If Yes, what is the Native Language:

Last School Attended:

Date Last Attended:

Does the household have Internet access ?

Reaquired field: YES

Reaquired field: NO

Does the household have a device that has camera and audio capabilities ?

Reaquired field: YES

Reaquired field: NO

Student resides with:

Reaquired field: Both Parents

Reaquired field: Mother

Reaquired field: Father

Reaquired field: Other

If Other, Name and Relationship:

Legal/Custody Papers?

Yes

Mother's First Name

Mother's Last Name

Mother's Home Phone Number

Mother's Street Address

Mother's City of Residence

Mother's Cell Phone

Mother's Email Address

Mother's Place of Employment

Mother's Work Phone

Father's First Name

Father's Last Name

Father's Home Phone Number

Father's Street Address

Father's City of Residence

Father's Cell Phone

Father's Place of Employment

Father's Work Phone

Guardian's First Name

Guardian's Last Name

Guardian's Home Phone Number

Guardian's Street Address

Guardian's City of Residence

Guardian's Cell Phone

Guardian's Place of Employment

Guardian's Work Phone

#1 Emergency Contact If Parents/Guardians are NOT Available (First Name):

#1 Emergency Contact (Last Name):

#1 Emergency Contact (Phone Number):

#1 Emergency Contact

Reaquired field: PERMISSION TO PICK UP STUDENT

#1 Relationship to Child:

#2 Emergency Contact If Parents/Guardians are NOT available (First Name):

#2 Emergency Contact (Last Name):

#2 Emergency Contact (Phone Number):

#2 Emergency Contact

Reaquired field: PERMISSION TO PICK UP STUDENT

#2 Relationship to Child:

Number of children in family Ages Girls and Boys

Required Fields

District	Campus	Directory
	CAMPUS

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Enrollment Form

Additional information will be required on actual enrollment date.