Enroll Now - Student Registration Form -

STUDENT INFORMATION

First Name*

Last Name*

Middle Name

Birth Date*

Gender*

Female

Male

CITIZENSHIP

US Citizen*

Yes

If not US citizen, indicate status

Immigrant

Nonimmigrant

Refugee

Country of Birth*

If Country of Birth is other than US, give year of arrival

ETHNICITY/RACE

Is the student Hispanic or Latino?*

Yes

I decline to provide ethnicity and race information. I understand that if I do not provide this information, a school representative will designate the
ethnicity and race categories for my child.

Initial

LANGUAGE

Other Language Spoken at Home

Other First Acquired Language

Other Language Most Used

PRIOR EDUCATION

Preschool Experience*

Yes

If “Yes” – attended

less than 6 months

between 6 and 12 months

more than 1 year

Pre-School Program: (if applicable)

EOEL

KALO

PDG

Last Hawaii Public School Attended

Year Attended

Last School Attended (if NOT Hawaii Public School)

Address

Phone

Fax

LEGAL PARENT/GUARDIAN LIVING IN THE HOUSEHOLD WITH STUDENT

1st Parent/Guardian

Prefix

Mr.

Mrs.

Ms.

Other (specify)

Other Prefix

Relation to Student

Marital Status*

Married

Divorced

Separated

Single

Custody of Child

Yes

Custody Type

Sole Custody

Physical Custody

Joint Legal

Custody Documentation Submitted

Yes

Legal Last Name*

Legal First Name*

Home Address*

APT#

City

Zip Code*

Home Phone #

Cellular Phone #

Pager #

Work Phone # (include ext.)

Email Address

Is this parent/guardian a member of the Armed Services, National Guard or Reserves?

Yes

Military Status

Traditional Reservist / M-Day

Active Duty (Title 10)

Federal Technician (Title 32)

Deployed?

Yes

Does this person work for the Federal Government or work on Federal Property?

Yes

2nd Parent Guardian