ENROLLMENT ASSESSMENT FORM

Enrolling Parent/Guardian/Caregiver
    
Address
    
City
    
State
   
ZIP
    
Contact Number
    
Relationship to Student
   
Enrolling Parent/Guardian/Caregiver Email
 

Legal Guardian
    
Address
    
City
    
State
Zip
    
Contact Number
    
I am seeking to enroll the above named student for the following reason(s): (Check ALL that apply)
Student's parent/legal guardian is incarcerated/in jail
Student's parent/legal guardian is in military on deployment
Student was placed with me by an agency (DHR, DYS, etc)
I have petitioned the court for legal custody
I am a student who is NOT living with a legal parent/guardian
I am living in a temporary housing situation
Other
Other Description  
Please explain the current situation (living, custody, etc.):