Student Information

If you are filling this out you are Zoned for Rogers Creek Elementary School

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* 1. Student's First Name (as it appears on the Birth Certificate)

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* 2. Student's Middle Name (as it appears on the Birth Certificate)

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* 3. Student's Last Name (as it appears on the Birth Certificate)

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* 4. Student's Preferred Name

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* 5. Student's Birth Date

Date

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* 6. Student's Gender

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* 7. Mother's Maiden Name

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* 8. Student's Race
(check all that apply)

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* 9. Student's Ethnicity
(check one)

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* 10. Address

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* 11. City

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* 12. ZipCode

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* 13. Mailing Address if different

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* 14. What is the first language your child learned to speak?

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* 15. What language is spoken most often when at home?

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* 16. What language is spoken most often outside of school?

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* 17. Number of people in the household

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* 18. List Other Children (and age) in the family: 

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* 19. Where does the child stay at night?

0 of 88 answered
 

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