Verification Of Student Admission Information (For Student Residing With Parent Or Guardian)/proof Of Residency Form Page 3
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13ROISD NEW STUDENT ENROLLMENT FORM
CAMPUS: ______________________
SCHOOL YEAR: __________
___ Check if Address or Phone# changed since Last Year
Student’s Social Security or State ID#________________________________ Student’s Local ID# (Skyward) ______________________
Student’s Legal Name (**) __________________________________________________________________________________________________________________
(Last)
(First)
(Middle)
(Name Student Goes By)
[**ROISD is required by the State of Texas to use the Student’s Legal Name as it appears on the student’s official birth certificate.]
Date of Birth________________ Age______ Grade________ Gender: ___Male___Female
Place of Birth (City, State)_________________________________________
Ethnicity: Hispanic YES__NO__ Fed Race: (check all that apply)__Am Indian/Alaskan Native __Asian__Black/African Am __Hawaiian/other Pacific Islander__White
Language Spoken in Home____________________________________Permission to Distribute Student Directory Information (see attached explanation) ___YES ___NO
Student’s Address__________________________________________________________________________________________ Primary Phone___________________
(Number/Street)
(Apt #)
(City)
(Zip)
Is there a Custody Judgment Regarding this Child that the School needs to have on file? __YES __NO
Has Student been Retained __YES __NO If YES, Grade______
Has student ever been enrolled in TX Public School? __YES __NO If yes, a Red Oak School? __YES__NO If YES: ___________________________________________
(Red Oak School)
(Last Grade or YR Enrolled)
List previous school attended: (not in Red Oak ISD):
________________________________________________________________________________________________________________________________________
(School & District)
(Grade)
(Entry/Withdrawal Dates)
(City)
(State)
FOR OFFICE USE ONLY
INDICATE IF THE STUDENT WAS PREVIUOSLY ENROLLED IN THE FOLLOWING PROGRAMS/SERVICES:
RECEIVED DOCUMENTATION
9TH GRADE COHORT
BIRTH CERTIFICATE
______ Special Education
District/Campus_____________________________________ Years_______
SOCIAL SECURITY CARD/STATE ID
______ Gifted/Talented Ed
District/Campus_____________________________________ Years_______
IMMUNIZATION RECORDS
______ 504
District/Campus_____________________________________ Years_______
PROOF OF RESIDENCE/DRIVER’S LICENSE
______ Title 1 Services
District/Campus_____________________________________ Years_______
______ Dyslexia
District/Campus_____________________________________ Years_______
PRE-KINDER DOCUMENTATION
______ Bilingual/ESL
District/Campus_____________________________________ Years_______
PREVIOUS SCHOOL RECORDS
SKYWARD STUD ID#___________________
DAYCARE NAME:
BUS NUMBER:
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
PARENT/GUARDIAN INFORMATION
(who child lives with)
__Both Parents or __Father __Step Father or __Mother __Step Mother or __Other Guardian
#1
Parent /Guard
____________________________________________________________________ Primary Phone#_______________Cell Phone#______________
(Last)
(First)
Parent’s Address____________________________________________________________________ Email Address_________________________________________
(Number/Street)
(Apt#)
(City)
(Zip)
Place of Employment______________________________________________________________________________________________________________________
(Name)
(City)
(Work Phone#)
#2
Parent /Guard
____________________________________________________________________ Primary Phone#_______________Cell Phone#______________
(Last)
(First)
Parent’s Address____________________________________________________________________ Email Address_________________________________________
(Number/Street)
(Apt#)
(City)
(Zip)
Place of Employment______________________________________________________________________________________________________________________
(Name)
(City)
(Work Phone#)
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
OTHER CHILDREN IN THE HOUSEHOLD ENROLLED IN ROISD
_______________________________________________________________________________________________________________________________________
(Name)
(Age)
(ROISD Campus)
(Relationship to Student)
_______________________________________________________________________________________________________________________________________
(Name)
(Age)
(ROISD Campus)
(Relationship to Student)
_______________________________________________________________________________________________________________________________________
(Name)
(Age)
(ROISD Campus)
(Relationship to Student)
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
EMERGENCY CONTACTS (Other than Parent/Guardian)
_______________________________________________________________________________________________________________________________________
(Emergency Contact #1)
(Phone)
(Other Phone)
(Relationship to Student)
_______________________________________________________________________________________________________________________________________
(Emergency Contact #2)
(Phone)
(Other Phone)
(Relationship to Student)
_______________________________________________________________________________________________________________________________________
(Emergency Contact #3)
(Phone)
(Other Phone)
(Relationship to Student)
_______________________________________________________________________________________________________________________________________
(Emergency Contact #4)
(Phone)
(Other Phone)
(Relationship to Student)
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
_____________________________________________________
______________
___________________________________ __________________________
(SIGNATURE OF PERSON ENROLLING STUDENT)
DOB
(Relationship to Student)
Date Enrolled
ENR-01
Page 1
rev. 2.24.2012
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