Northshore School District Enrollment Form
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4FOR SCHOOL USE ONLY Proof of Age ____________
Proof of Residency _________________
Student ID # _________________
School __________________
Service Area _____________
Waiver District _____________________
Class of _____________________
Admit Reason ___________
Enter Date ______________
Bus # to School ____________________
Bus # from School _____________
Diploma Type ___________
Records Requested ________
Records Received ___________________
NORTHSHORE SCHOOL DISTRICT ENROLLMENT FORM
(Rev. 12/17/2014)
BASIC STUDENT DEMOGRAPHICS
Grade Level _________________
Legal Last Name __________________________________________
Legal First Name __________________________________________
Last Name goes by __________________________________________
Nickname _________________________________________________
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Middle Name __________________________________
Date of Birth ________________________________
Gender
M
F
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Home Phone (_______) __________________________________
Unlisted?
Yes
No
Student’s Cell Phone (_______) _______________________________
Student’s Email Address _____________________________________
Home Address ____________________________________________________________________________
Apt # ______________________
City _______________________________________________
County ____________________________
Zip ________________________
Mailing Address (if different) ______________________________________________________________________________________________
City _______________________________________________
State ______________________________
Zip ________________________
Part 1
Is your child of Hispanic or Latino origin?
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(You must check at least one of the following categories
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Not Hispanic/Latino
Spaniard
Central American
Other Hispanic/Latino
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Cuban
Puerto Rican
Latin American
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Dominican
Mexican/Mexican American/Chicano
South American
Part 2
What race(s) do you consider your child?
)
(You must check at least one of the following categories
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African American/Black
White
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Asian Indian
Hmong
Laotian
Taiwanese
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Cambodian
Indonesian
Malaysian
Thai
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Chinese
Japanese
Vietnamese
Pakistani
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Filipino
Korean
Singaporean
Other Asian
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Native Hawaiian
Guamanian or Chamorro
Melanesian
Samoan
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Fijian
Mariana Islander
Micronesian
Tongan
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Other Pacific Islander
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Alaska Native
Lummi
Quinault
Stillaguamish
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Chehalis
Makah
Samish
Suquamish
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Colville
Muckleshoot
Sauk-Suiattle
Swinomish
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Cowlitz
Nisqually
Shoalwater
Tulalip
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Hoh
Nooksack
Skokomish
Yakama
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Jamestown
Port Gamble Klallam
Snoqualmie
Other Washington
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Kalispel
Puyallup
Spokane
Indian
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Lower Elwha
Quileute
Squaxin Island
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Other American Indian/Alaska Native
Special Programs
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(Check all special programs or services in which the student has participated.)
None Apply
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Special Education / IEP / OT / PT / Speech Therapy
ESL / ELL
Gifted / Highly Capable
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Reading or Math Support (LAP / LASER / Title I)
Head Start
Native American Education
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International Baccalaureate
Summer School
Other: ___________________
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(continued on next page)
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