Sequoia Pathfinder Academy at Eastmark Pre-Registration Form


STUDENT INFORMATION
What school would you like to pre-enroll the student into?
Student's Legal Name (Last, First, Middle):
Birth State:
Today's Date:
Home Address:
City:
  
State:
  
Zip:
  
(Choose One)
Male Female
Home Phone Number
Birth Date (Month, Day & Year)
Language Spoken at Home:
SAIS # (if known):
Hispanic/Latino?:
Tribe (if Native American):
Ethnic Origin: (Select all that apply)
White Black or African American Asian American Indian or Alaska Native Native Hawaiian or Other Pacific Islander Other
Last School Attended:
Address of Last School:
Grade This School Year (2016-2017):
Expected Grade Next Year (2017-2018):
Are you enrolling for the current semester or a future semester?:
Where did you hear about Sequoia Schools?:
Did Student Receive Special Education Services at Previous School?
YES NO If Yes, Date of Last I.E.P.:
Has Student Been Suspended or Expelled from any School?
YES NO If Yes, Date & School:

FAMILY INFORMATION
Parent / Legal Guardian (Last, First, Middle):
Father/Mother/Other (Specify Please):
Place of Employment:
Email Address:
Home Phone Number:
Work Phone Number:
Cell Phone Number:
Parent / Legal Guardian (Last, First, Middle):
Father/Mother/Other (Specify Please):
Place of Employment:
Email Address:
Home Phone Number:
Work Phone Number:
Cell Phone Number:
Please list all other schools your child has attended.
NAME OF SCHOOL   ADDRESS
 
 
 
 

1. What is the primary language used in the home regardless of the language spoken by the student?

2. What is the language most often spoken by the student?

3. What is the language that the student first acquired?

SIGNATURE OF THE PARENT OR GUARDIAN DATE





For additional information, please consult the enrollment packet and instructions below or visit the contact us page.