Carter G. Woodson School Change of Information Form / Formulario de Actualización de Información de Carter G. Woodson School
Please use this form to notify Carter G. Woodson School of changes to your student’s contact, household, emergency, or other important information. Submit this form as soon as possible after a change occurs. The school may contact you to verify the information before updating the student’s official record. Utilice este formulario para informar a Carter G. Woodson School sobre cambios en la información de contacto, domicilio, contactos de emergencia u otra información importante de su estudiante. Envíe este formulario lo antes posible después de que ocurra un cambio. La escuela puede comunicarse con usted para verificar la información antes de actualizar el expediente oficial del estudiante. Do not use this form for emergencies. If you have an urgent safety or medical concern, contact the school directly. No utilice este formulario para emergencias. Si tiene una inquietud urgente de seguridad o salud, comuníquese directamente con la escuela.
Authorized Pickup Person
Are you adding or removing an authorized pickup person? / ¿Está agregando o eliminando a una persona autorizada para recoger al estudiante?
*
Add / Agregar
Remove / Eliminar
Authorized Person’s First and Last Name / Nombre y apellido de la persona autorizada
Relationship to Student / Relación con el estudiante
Authorized Person’s Phone Number / Número de teléfono de la persona autorizada
Please enter a valid phone number.
Format: (000) 000-0000.
Authorized pickup persons may be required to show a valid photo ID before the student is released. / Las personas autorizadas para recoger al estudiante pueden tener que presentar una identificación válida con fotografía antes de que el estudiante sea entregado.
Household or Custody Information
Please explain the household or custody information that needs to be updated. / Explique la información del hogar o de custodia que necesita actualizarse.
Upload supporting legal or custody documentation, if applicable. / Suba la documentación legal o de custodia correspondiente, si aplica.
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Medical or Health Information
Please briefly describe the medical or health information that has changed. / Describa brevemente la información médica o de salud que ha cambiado.
The school may contact you for additional information or direct you to the appropriate school health staff. Do not use this form for a medical emergency. / La escuela puede comunicarse con usted para solicitar información adicional o dirigirlo al personal de salud escolar correspondiente. No utilice este formulario para una emergencia médica.
Transportation Information
Please describe the transportation change or concern. / Describa el cambio o la inquietud relacionada con el transporte.
Requested Effective Date / Fecha solicitada para que entre en vigor
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submitting this form does not guarantee an immediate transportation change. The school will contact you when the request has been reviewed. / Enviar este formulario no garantiza un cambio inmediato de transporte. La escuela se comunicará con usted cuando la solicitud haya sido revisada.
Other Important Information
Please describe the information the school needs to know. / Describa la información que la escuela necesita saber.
Supporting Documentation / Suba cualquier documentación de respaldo relacionada con este cambio.
Upload a File
Drag and drop files here
Choose a file
Cancel
of
I certify that the information provided is accurate and that I am authorized to request changes to this student’s records. I understand that Carter G. Woodson School may contact me to verify this request before updating the student’s official information. / Certifico que la información proporcionada es correcta y que estoy autorizado(a) para solicitar cambios en los registros de este estudiante. Entiendo que Carter G. Woodson School may contact me to verify this request before updating the student’s official information.
*
Parent/Guardian Information
Parent/Guardian Name / Nombre del padre, madre o tutor
First Name
Last Name
Relationship to Student / Relación con el estudiante
Please Select
Mother / Madre
Father / Padre
Legal Guardian / Tutor legal
Grandparent / Abuelo(a)
Foster Parent / Padre o madre de acogida
Other / Otro
Current Phone Number / Número de teléfono actual
Please enter a valid phone number.
Format: (000) 000-0000.
Current Email Address / Correo electrónico actual
example@example.com
Student Information
Student First Name / Nombre del estudiante
Student Last Name / Apellido del estudiante
Student ID Number / Número de identificación del estudiante
Grade Level / Nivel de grado
Please Select
Kindergarten / Kínder
1st Grade / 1.er grado
2nd Grade / 2.º grado
3rd Grade / 3.er grado
4th Grade / 4.º grado
5th Grade / 5.º grado
6th Grade / 6.º grado
7th Grade / 7.º grado
8th Grade / 8.º grado
9th Grade / 9.º grado
10th Grade / 10.º grado
11th Grade / 11.º grado
12th Grade / 12.º grado
Effective Date of Change / Fecha de vigencia del cambio
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Information Being Updated / Tipo de información que se actualizará
Home Address / Domicilio
Mailing Address / Dirección postal
Parent/Guardian Phone Number / Número de teléfono del padre, madre o tutor
Parent/Guardian Email Address / Correo electrónico del padre, madre o tutor
Emergency Contact / Contacto de emergencia
Authorized Pickup Person / Persona autorizada para recoger al estudiante
Household or Custody Information / Información del hogar o de custodia
Medical or Health Information / Información médica o de salud
Transportation Information / Información de transporte
Other Important Information / Otra información importante
Phone Number Update
Whose phone number is changing? / ¿De quién es el número de teléfono que está cambiando?
Previous Phone Number / Número de teléfono anterior
Please enter a valid phone number.
Format: (000) 000-0000.
New Phone Number / Nuevo número de teléfono
Please enter a valid phone number.
Format: (000) 000-0000.
Phone Type / Tipo de teléfono
Please Select
Mobile / Celular
Home / Casa
Work / Trabajo
May the school send text messages to this number? / ¿Puede la escuela enviar mensajes de texto a este número?
Yes
No
Email Address Update
Whose email address is changing? / ¿De quién es la dirección de correo electrónico que está cambiando?
Previous Email Address / Dirección de correo electrónico anterior
example@example.com
New Email Address / Nueva dirección de correo electrónico
example@example.com
Emergency Contact Update
Are you adding, updating, or removing an emergency contact? / ¿Está agregando, actualizando o eliminando un contacto de emergencia?
Add / Agregar
Update / Actualizar
Remove / Eliminar
Emergency Contact’s First and Last Name / Nombre y apellido del contacto de emergencia
Relationship to Student / Relación con el estudiante
Emergency Contact’s Phone Number / Número de teléfono del contacto de emergencia
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Email Address / Dirección de correo electrónico de contacto de emergencia
example@example.com
Address Update
Dirección anterior / Previous address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Nueva dirección / New address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Submit
Should be Empty: