STEWART COUNTY SCHOOLS
(WHERE CHOICES ARE GIVEN, CIRCLE ONE)
NAME: _________________________________________________________________
SEX: MALE FEMALE
RACE: ASIAN BLACK HISPANIC INDIAN WHITE PACIFIC ISLANDER
GRADE: __________ DATE ENROLLED: _____________/______________/______________
BIRTHDATE: ____________/______________/_______________
SOCIAL SECURITY NUMBER: ______________-_______________-_______________
I/WE HAVE LEGAL GUARDIANSHIP OF STUDENT (1) Both (2) Mother (3) Father (4) Other
(If child does not live with biological parent(s) then legal documents concerning child custody, adoption, and guardianship must be on file in school office.)
Number of brothers: Younger ________ Older _________ Number of sisters: Younger ________ Older _________
Father’s Name _______________________ Education __________________________
Employer ___________________________ Occupation ______________________ Work Phone ______________
Mother’s Name ______________________ Education __________________________
Employer ___________________________ Occupation ______________________ Work Phone ______________
NAME OF PARENT OR GUARDIAN WITH WHOM CHILD LIVES:
_________________________________________________________________________________________
ADDRESS: _______________________________________________________________________________
CITY: ____________________________ STATE: __________________ ZIP: ________________________
PHONE NUMBER: _______________________ EMERGENCY PHONE #: ___________________
MORNING BUS # _________ AFTERNOON BUS # _________ MILES RIDDEN ON BUS ___________
SCHOOL LAST ATTENDED: ________________________________________________________________
ADDRESS: _______________________________________________________________________________
CITY: ____________________________ STATE: __________________ ZIP: ________________________
PHONE NUMBER: ______________________________________
IS ENGLISH PRIMARY LANGUAGE: YES NO
PLACE OF EMPLOYMENT: FATHER ____________________ MOTHER ____________________
DOES EITHER PARENT OR GUARDIAN WORK OR LIVE ON FEDERAL PROPERTY: YES NO
IF YES, NAME AND ADDRESS OF WHERE: _______________________________________________
HOMEROOM TEACHER: ________________________________________________________________