Student Demographic Information

Student's Last Name *

Student's First Name *

Middle Initial

Student's Date of Birth (Provide Original Birth Certificate) * +

Entering Grade *

Gender *

Male

Female

Did your child previously attend Academy of Warren? *

Yes

No

Student's Street Address *

City *

State *

Zip Code *

Is your child's mailing address different from his/her street address? *

Yes

No

Student's Mailing Address

City

State

Zip Code

Parent/Guardian (1) Name *

Relationship (to student) *

Parent/Guardian (1) Street Address *

City *

State *

Zip Code *

If this address is different than the student, would you like separate mailings to this address as well?

Yes

No

Home Phone

Cell Phone *

Work Phone

Email Address *

Email Address Confirmation *

Does your child have another parent/legal guardian that you would like to include on his/her student profile? *

Yes

No

Parent/Guardian (2) Name *

Relationship to Student *

Parent/Guardian (2) Street Address *

City *

State *

Zip Code *

Home Phone

Cell Phone *

Work Phone

Email Address

Email Address Confirmation

If this address is different than the student, would you like separate mailings to this address as well?

Yes

No

Is the student's parent or guardian currently on active duty for any branch of the military? *

Yes

No

If yes, which branch

The next two questions must be completed. The U.S. Department of Education requires the Academy to supply an answer on your behalf.

Is your child Hispanic/Latino? *

Yes

No

What is the race of the child? (Choose one or more boxes) *

The next three items are not required, however the information will be used to determine whether the school is eligible for supplemental funding to enhance instructional opportunities for immigrant children and youth.

Is your child between the ages of 3 and 21?

Yes

No

Was your child born outside of the United States? ("United States" is defined as the 50 states, the District of Columbia and the Commonwealth of Puerto Rico)

Yes

No

Has your child attended one or more schools in the United States for less than three full academic years?

Yes

No

The next two items are not required, however, it is necessary to determine if your child is eligible for English Language Support.

Is your child's native tongue a language other than English?

Yes

No

If yes, what is the language?

What is the primary language spoken in your home?

Has your child previously attended another school? *

Yes

No