New Student Registration Form

Student First Name*

Student Middle Name

Student Last Name*

Student Gender*

FemaleMaleOther

Student Grade*

Address where student resides*

Student Birthdate*

MonthDayYear

Student Birthplace

Please include city, state, and country of birth

Has your student attended a Vallejo School/Preschool?*

YesNo

If yes, what's the name of the school?

School Last Attended

School Phone Number

Last School Address

Date Student Left Previous School

MonthDayYear

Ethnicity:

Is this student Latino/Hispanic?*

YesNo

Native American/Indigenousness with Tribal Affiliation*

YesNo

Race:

RACE CODING (State and Federal required information)

Local, State and Federal guidelines require that the race of your children(s) be reported. Choose the race code that your student most closely identifies with. (NOTE: If you do not choose a race, by law the School/District will make a determination for reporting purposes.)

Please select one of the choice(s) below. Please write the ONE choice that will be used for State and Federal reports.

Hispanic/Latin: A person of Mexican descent, from Puerto Rico, Cuba, Central America or South America or from another culture or Latin origin regardless of the race.

Hispanic or Latin (500)

White (Not of Hispanic Origin): A person having origins in any of the original peoples of Europe, North Africa, or Middle East.

White (700)

African-American (Not of Hispanic Origin): A person having origins in any of the black African racial groups.

African-American (600)

Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent.

Chinese (201) Japanese (202) Korean (203) Vietnamese (204) Asian Indian (205) Laotian (206) Cambodian (207) Hmong (208) Other Asian (299)

American Indian/Alaskan Native: A person having origins in any North and South America (including Central America) who maintain tribal affiliation or community attachment. Amer.

Indian/Alaska Native (100)

Filipino: A person having origins in any of the original peoples of the Philippine Islands.

Filipino (400)

Pacific Islanders: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other PacificIslands, excluding the Philippines Islands.

Hawaiian (301) Guamanian (302) Samoan (303) Tahitian (304) Other Pacific Islander (399)

Race Code*

Child is living with (Check one or more)*

MotherFatherLegal Guardian/Foster ParentAuthorized Caregiver

Information For The:

MotherStepmotherLegal Guardian/Caregiver

First Name

Last Name

Parent Phone Number

Parents Email Address

Employed by

Work Phone

Parent Education Level*

Information For The:

FatherStepfatherLegal Guardian/Caregiver

First Name

Last Name

Parent Phone Number

Parents Email Address

Employed by

Work Phone

Parent Education Level*

Parent/Guardian is a member of the Armed Forces (Army, Navy, Air Force, Marine Corps, or Coast Guard) on active duty.*

YesNo

Family Language: What language would you like us to use when communicating with you?*

EnglishSpanishTagalogOther

Which language did your child first learn to speak?*

Which language does your child use most frequently at home?*

Which language do you most frequently use to speak to your child?*

Which language is most often spoken by the adults in your home?*

Has this student ever been retained?*

YesNo

If yes, what grade

Has this student ever been expelled?*

YesNo

If yes, what grade?

Does the student have a current IEP? *

YesNoUnknown

What grade was Special Education Services last provided

Check all services that apply to this student:

Resource Specialist ProgramSpecial Day ClassDIS/Speech TherapyOther

Does your student have a 504 Accommodation Plan:*

YesNoUnknown

Does this student have Asthma?*

YesNo

Does this student have Health Insurance?*

YesNo

Name of Insurer

Any other special health issues/severe Allergies

Medications to be administered at school

Student Birth Certificate

Browse Files

Immunization Records

Browse Files

Proof of Address

Browse Files

Student Information

Parental Information

Home Language Survey

Special Education/Disability Services:

Health:

Documentation