Verification Of Student Admission Information (For Student Residing With Parent Or Guardian)/proof Of Residency Form Page 5
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13Red Oak Independent School District
P.O. Box 9000, Red Oak, Texas 75154
Home Language/Migrant Survey
Pre-Kindergarten – grade 12
Student’s Name:________________________________________
ID#__________________________
School: ________________________________ Grade: __________ Date: _______________________
Please provide the following information to help us place the student in the appropriate instructional
program.
Mark your responses with ( ).
1. What language is spoken in your home most of the time?*
English __________Spanish __________ Other ___________________ (Specify Language)
2. What language does your child speak most of the time?*
English __________ Spanish __________ Other ___________________ (Specify language)
3. Has your family moved any time during the last three years from one school district to another in
Texas, from another state, or outside the USA? Yes______ No ______
4. Were any of these moves made to find temporary or seasonal work in agriculture, agriculture
related (packing, processing, harvesting, cultivating or crops), food processing, dairy work,
forestry, fishing, ect.?
Yes______ No ______
If you answered “Yes” to question #4 above, please complete the information below.
Name of Parent/Guardian: ______________________________________________________
Address: _____________________________________________________________________
Telephone:___________________________________________________________________
PRIOR EDUCATIONAL EXPERIENCES (GRADES 2-12)
1. Has the student lived outside of the U.S. for two or more consecutive years? ______Yes _______No
If yes, Where and When? _____________________________________________________________
2. What is the date the student first enrolled in the U.S.? ______________________________________
3. What school/district did the student attend prior to this one? __________________________________
4. Did the student attend school regularly while residing outside of the U.S.? ______Yes _______ No
Indicate the grade levels completed: ___pre-k ___k ___1 ___2 ___4 ___5 ___6 ___7 ___8
___9 ___10 ___ 11 ___12
I certify that the above information is true and correct to the best of my knowledge.
FOR OFFICE USE ONLY
Grades pre-k – 8:_______________________________
Parent or Guardian’s Signature
Note to Registrar:
*An answer of a language other than English to
Grades 9-12:_______________________________
either or both questions will require notification of
Parent, Guardian, or Student’s signature
the Bilingual and ESL teachers.
*If parents answer #4, please forward a copy to
District Migrant Coordinator, Sylvia Chastain.
ENR-02
rev. 3.2011
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