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    tiger

    Sharon City School District

    Sharon, PA 16146 PHONE: (724) 983-4000 FAX: (724) 981-0844

    REGISTRATION FORM

    Enrolling School: (circle one)

    SHARON M/HS CASE AVENUE C. M. MUSSER WEST HILL




    STUDENT INFORMATION


    Student's Legal Name_________________________________________________________________________

    Last First Middle


    Street Address: _________________________________ City: _________________ ZIP Code: ____________


    Mailing Address(if different from above): Postal Box: ________________________ ZIP Code: ________________


    Birthdate: _____/______/______ Age: ________ Grade: _______ Social Security Number: _____ - ___ - _____

    Year Month Day


    9thGrade Entry Date(if applicable):___________ State Entry Date: ______________US Entry Date: _______________


    Sex: ħMale ħFemale Citizenship: ħUnited States ħOther City/State of Birth: __________________________


    Siblings: ____________________________ ____________________________ ___________________________

    (name and age) (name and age)(name and age)

    Office Use only:

    Student ID# ______________________ Building Assigned____________________________________


    PARENTS AND/OR GUARDIANS


    Father's Name: ______________________________________________________________________________

    Mailing Address (if different): ____________________________________________________________________

    Phone #: ____________________________________ Lives with Student ħYes ħNo

    Mother's Name: ______________________________________________________________________________

    Mailing Address (if different): ____________________________________________________________________

    Phone #: ____________________________________ Lives with Student ħYes ħNo

    Guardian (or Host Family) Name: _______________________________________________________________

    Mailing Address (if different): _____________________________________________________________________

    Phone #: ____________________________________ ZIP Code: ________________________

    Student is considered independent(not living at home): ħYes ħNo


    LAST SCHOOL ATTENDED:


    Name of School: _____________________________________________ Grade: ___________________

    Address: ___________________________________________________ ZIP Code:__________________

    Phone Number: _______________________Has the student attended Sharon Schools previously? ħYes ħNo

    W

    OVER PLEASE

    as the student ever enrolled in another P

    A school? ħYes ħNo If so where? _________________________



    CUSTODY:

    Please indicate if the school administration should be aware of any Custody/Court Order related to your child.

    Yes ħNo If yes, please make arrangements to discuss this situation with the school

    administration. Legal documentation will be required.


    SPECIAL PROGRAMMING:

    Does this student have needs that require special considerations?

     ESL ƒßPsych Evaluation and/or IEP ƒß504 Plan ƒßBehavioral ƒßPhysical/Medical ƒßGIEP

     Educational ƒßOther

    Please explain: _______________________________________________________________________________

    _________________________________________________________________________________________

    _________________________________________________________________________________________



    SIGNATURE:


    I hereby declare that I have read and understood the information contained on this form and the information I have provided is correct.


    Parent/Guardian Signature ____________________________________________________


    Date of Registration: __________________



    The information requested on this form is being collected pursuant to the School Code, Sections 1301, 1302, 1303, 1304, 1326; HIPPA, FERPA and district policies 200, 201, 202 . Information acquired through this form is kept secure and access is restricted.



     

Last Modified on February 6, 2009