Safe School Plan - William S. Hart Union High School District

WILLIAM S. HART UNION HIGH SCHOOL DISTRICT ENROLLMENT FORM
School Name ____________________________________________ Date of Enrollment ______________________________
Student’s Legal Name ________________________________________________________________ Male __________ Female _______
(Last) (First) (Middle)
Residence ______________________________________________________________________ Birth Date ________________________
(Street Address) (City) (Zip Code)
Home Phone __________________ Cell Phone/Pager _____________________ Grade ________Place of Birth: _______________________
Race/Ethnicity (Optional)
_____Other Asian _____Asian Indian _____Japanese _____Samoan
_____Black, not of _____Filipino _____Korean _____Tahitian
Hispanic Origin _____Guamanian _____Laotian _____Vietnamese
_____Chinese _____Hispanic _____Hawaiian _____White, not of
_____Cambodian _____Amer. Indian/Alaskan Native _____Other Pacific Islander Hispanic Origin
Name of Last School Attended __________________________________ Phone Number _________________________________________
Address of Last School Attended ______________________________________________________________________________________
Last Date Attended ___________________________________ Special Programs (i.e., RS, SC, Gate, ELA)___________________________
Attended the Wm. S. Hart District Before? __________ Dates Attended ____________________ Name of School _____________________
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The California Education Code requires schools to determine the language(s) spoken at home by each student. Please answer the following
questions.
1. Which language did your son/daughter learn when he/she first began to talk? _______________________________________
2. Which language does your son/daughter most frequently use at home? _______________________________________
3. What language do you use most frequently to speak to your son/daughter? _______________________________________
4. What language is most often spoken by the adults at home? _______________________________________
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Student lives with: (Please check all that apply.)
____Mother ____Father ____Step-mother ____Step-father ____Guardian ____Foster Parent
Name of those checked: 1. 2. _________________________________________
Relationship to Student _______________________________________ ________________________________________
Work Phone(s): _______________________________________ ________________________________________
Occupation: _______________________________________ ________________________________________
Email Address: _______________________________________ ________________________________________
Highest Parent Education Level of any Parent/Guardian:
____Not a High School Grad ____Some College or AA Degree ____Graduate School/Post Grad
____High School Grad ____College Grad ____Decline to State/Unknown
Parent/Guardian Signature X ________________________________________________________ Date___________________________
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FOR OFFICE _____Counselor _____Immunizations _____Records Requested
USE ONLY _____Primary Language _____Proof of Residence _____Attendance Category
WSHUHSD enrollment form – 2/11/03, revised 5/17/04
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