Williamson County Schools

Enrollment Data Form

Student Information:(Please Print) Enrolling School:

Student’s Legal Full Name: __________________, __________________, ___________________ Grade _______

Last First Middle

Student’s Preferred Name: ________________________ Home Phone: ____________________________

Birthdate: _____/_____/_____ Gender: M _____ F _____ Student’s SSN or ID#: _________________

Race: White _____ African-American _____ Hispanic _____ Native American _____ Asian/Pacific Islander ____

Physical Address

Street Address: _____________________________ City: ___________________ State: _______ Zip: __________

Subdivision: ________________________________ Apartment: __________________________________

Mailing Address: __________________________________________________________________________

(if different from physical)

Rides AM Bus: Yes _____ No _____ Rides PM Bus: Yes _____ No _____ If riding bus one time, please indicate yes.

Last School Attended: _________________________

School Address: _____________________________City: ________________ State: _____ Zip: _____

Date Enrolled: ______________________________ Date Withdrawn: ___________________________

Has student attended a Tennessee public school within last 12 months? ______ Y ______ N

Any Special Services student received in previous school: ______ Y ______ N (If yes, please explain.) ________________

Family Information

Custodial Parent/Guardian Full Names: ______________________________________________________

Custody: Both Parents _____ Mother _____ Father _____ Guardian _____ Student lives with: ________________

If for any reason the noncustodial parent is not allowed visitation rights and does not have the right to remove the student from school, we must have a

legal document from the custodial parent to support this order.

Father’s Name&Work Place: ______________________________________ Phone: __________________________

Mother’s Name&Work Place: _____________________________________ Phone: __________________________

Mother’s Phone (Cellular #) _________________________ Father’s Phone (Cellular #) _______________________

Mother’s Email ______________________________________________________ Father’s Email ___________________________________________________

Local Emergency Contact Person: _________________________________ Phone: __________________________

(other than parent) Name Relationship

Sibling(s) currently attending the WCS: 1) _______________________ 2) _____________________ 3) _____________________

Home Language (Must be completed for ALL students)

Country of Birth: U.S.A. _____ Other _____________ Date entered U.S.: __________ Date entered U.S. school: ___________

Student’s first language? _______________________ Main language spoken at home? __________________________________

Other languages spoken at home: ____________________________ Did student receive ESL in previous school? __________

Homeless: ______ Y ______ N If yes, has paperwork been completed? ____________________________________________

Parent/Guardian Signature: __________________________________________________ Date: __________________________

Proof of Residency: ______ Utility Bill ______ Non-Contingent Contract/Settlement Statement ______ Lease Agreement Other __________________

Date Revised: 11/18/05