Family Last Name (Account Name) Campus Student(s) Attend Date of Application ⃝ Desert Oasis Elementary ⃝ Nadaburg Elementary Parent/Guardian Name Home Phone Cell Phone Work Phone #1 Street Address City St Zip Code Child Lives with or ⃝Yes ⃝ No Email Address Relationship Educational Rights Guardian Parent ⃝ Yes ⃝ No Parent/Guardian Name Home Phone Cell Phone Work Phone #2 Street Address City St Zip Code Child Lives with or ⃝Yes ⃝ No Email Address Relationship Educational Rights Guardian Parent ⃝ Yes ⃝ No Student First and Last Name Date of Birth Age Grade Gender Ethnicity Homeroom Teacher IEP or 504 Plan ELL Student Gifted Student ⃝Yes ⃝ No ⃝ Yes ⃝ No ⃝ Yes ⃝ No #1 Program Enrolling For Custody Documents ⃝ Assets Before/After School ⃝ Yes ⃝ No ○ Monday ○ Tuesday ○ Wednesday ○ Thursday ○ Friday Student ⃝ Preschool 3-5 ⃝ Extended Preschool 3-5 ⃝ Early Head Start Information Student First and Last Name Date of Birth Age Grade Gender Ethnicity Homeroom Teacher IEP or 504 Plan ELL Student Gifted Student ⃝Yes ⃝ No ⃝ Yes ⃝ No ⃝ Yes ⃝ No #2 Program Enrolling For Custody Documents ⃝ Assets Before/After School ⃝ Yes ⃝ No ○ Monday ○ Tuesday ○ Wednesday ○ Thursday ○ Friday ⃝ Preschool 3-5 ⃝ Extended Preschool 3-5 ⃝ Early Head Start Student Information Student First and Last Name Date of Birth Age Grade Gender Ethnicity Homeroom Teacher IEP or 504 Plan ELL Student Gifted Student ⃝Yes ⃝ No ⃝ Yes ⃝ No ⃝ Yes ⃝ No #3 Program Enrolling For Custody Documents ⃝ Assets Before/After School ⃝ Yes ⃝ No ○ Monday ○ Tuesday ○ Wednesday ○ Thursday ○ Friday Student ⃝ Preschool 3-5 ⃝ Extended Preschool 3-5 ⃝ Early Head Start Information Student First and Last Name Date of Birth Age Grade Gender Ethnicity Homeroom Teacher IEP or 504 Plan ELL Student Gifted Student ⃝Yes ⃝ No ⃝ Yes ⃝ No ⃝ Yes ⃝ No #4 Program Enrolling For Custody Documents ⃝ Assets Before/After School ⃝ Yes ⃝ No ○ Monday ○ Tuesday ○ Wednesday ○ Thursday ○ Friday ⃝ Preschool 3-5 ⃝ Extended Preschool 3-5 ⃝ Early Head Start Student Information For Additional children please complete the Additional Student Form, and attach to this application.
Family Last Name (Account Name) Campus Student(s) Attend Date of Application ⃝ Desert Oasis Elementary ⃝ Nadaburg Elementary Parent or Guardian #1 Parent/Guardian Name Home Phone Cell Phone Work Phone Street Address City St Zip Code Child Lives with ⃝Yes ⃝ No Email Address Relationship Educational Rights ⃝ Yes ⃝ No Parent or Guardian #2 Parent/Guardian Name Home Phone Cell Phone Work Phone Street Address City St Zip Code Child Lives with ⃝Yes ⃝ No Email Address Relationship Educational Rights ⃝ Yes ⃝ No Student #1 Information Student First and Last Name Date of Birth Age Grade Gender Ethnicity Homeroom Teacher IEP or 504 Plan ELL Student Gifted Student ⃝Yes ⃝ No ⃝ Yes ⃝ No ⃝ Yes ⃝ No Program Enrolling For Custody Documents ⃝ Assets Before/After School ○ Monday ○ Tuesday ○ Wednesday ○ Thursday ○ Friday ⃝ Preschool 3-5 ⃝ Extended Preschool 3-5 ⃝ Early Head Start ⃝ Yes ⃝ No Student #2 Information Student First and Last Name Date of Birth Age Grade Gender Ethnicity Homeroom Teacher IEP or 504 Plan ELL Student Gifted Student ⃝Yes ⃝ No ⃝ Yes ⃝ No ⃝ Yes ⃝ No Program Enrolling For Custody Documents ⃝ Assets Before/After School ○ Monday ○ Tuesday ○ Wednesday ○ Thursday ○ Friday ⃝ Preschool 3-5 ⃝ Extended Preschool 3-5 ⃝ Early Head Start ⃝ Yes ⃝ No Student #3 Information Student First and Last Name Date of Birth Age Grade Gender Ethnicity Homeroom Teacher IEP or 504 Plan ELL Student Gifted Student ⃝Yes ⃝ No ⃝ Yes ⃝ No ⃝ Yes ⃝ No Program Enrolling For Custody Documents ⃝ Assets Before/After School ○ Monday ○ Tuesday ○ Wednesday ○ Thursday ○ Friday ⃝ Preschool 3-5 ⃝ Extended Preschool 3-5 ⃝ Early Head Start ⃝ Yes ⃝ No Student #4 Information Student First and Last Name Date of Birth Age Grade Gender Ethnicity Homeroom Teacher IEP or 504 Plan ELL Student Gifted Student ⃝Yes ⃝ No ⃝ Yes ⃝ No ⃝ Yes ⃝ No Program Enrolling For Custody Documents ⃝ Assets Before/After School ○ Monday ○ Tuesday ○ Wednesday ○ Thursday ○ Friday ⃝ Preschool 3-5 ⃝ Extended Preschool 3-5 ⃝ Early Head Start ⃝ Yes ⃝ No For Additional children please complete the Additional Student Form, and attach to this application.
SY1718%20Community%20Education%20Application.docx