office use only · chinese health history. title: microsoft word - ausd enrollment revisions -...

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S T U D E N T E NR OL L M E NT FOR M ��

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STUDENT INFORMATION �

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FAMILY INFORMATION (NOT EMERGENCY CONTACT INFORMATION)

Student Lives� �%RWK�3DUHQWV� � �)DWKHU�RQO\� � �0RWKHU�RQO\� � �/HJDO�*XDUGLDQ�V����������With�� �)DWKHU�DQG�6WHSPRWKHU� �0RWKHU�DQG�6WHSIDWKHU� �)RVWHU�3DUHQWV�� �2WKHU��� � � � � � � � � � � � ��BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB�

Is this student court placed or a foster child? � <HV ��� 1R����,I�FRXUW�RUGHUHG��SOHDVH�SURYLGH�FRXUW�GRFXPHQWDWLRQ��

FATHER/LEGAL GUARDIAN NAME

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MOTHER/LEGAL GUARDIAN NAME

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Primary Contact (please check one only): �)DWKHU�/HJDO�*XDUGLDQ������ �0RWKHU�/HJDO�*XDUGLDQ�

Preferred  Parent’s  Email  Address  (one only please):BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB�

Home Correspondence Language (used for district/school mailings)��� (QJOLVK� &KLQHVH� 6SDQLVK� 9LHWQDPHVH��

Home Phone Language (used for phone calls home)��� (QJOLVK���� &DQWRQHVH� 0DQGDULQ� 6SDQLVK� 9LHWQDPHVH���

STATE MANDATED INFORMATION (Required by the California State Department of Education) What is your child’s  ethnicity? (please check one) �Hispanic or Latino�(A person of Cuban, Mexican, Puerto Rican, South or

Central American, or other Spanish culture or origin, regardless of race) �Not Hispanic or Latino

What is your child’s  race? (Required for ALL students. Please check up to a maximum of five racial categories)

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OFFICE USE ONLY 7HDFKHU� +RPHURRP� )RUP�3URFHVVHG�%\�BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB�$))� 925�&6,6� 307�5(6� +/6�Form 3730 Rev. 03/11 � �

OFFICE USE ONLY

�Please Print Clearly with Black or Blue Ink

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OTHER CHILDREN LIVING IN THE HOME �

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ACADEMIC HISTORY �

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Previous Schools Attended (please include ALL previous schools):

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SCHOOL AND SPECIALIZED EDUCATION PROGRAMS 0\�FKLOG�LV�UHFHLYLQJ�RU�KDV�UHFHLYHG�VHUYLFHV�LQ��SOHDVH�FKHFN�DOO�WKDW�DSSO\����

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1515 W. Mission Road Alhambra, CA 91803

(626) 943-3400 FAX (626) 943-8033 Dear Parents/Guardians: This letter is to inform you of the possibility of your child being transferred to another school within the Alhambra Unified School District, due to maximum student enrollment in certain grade levels at your neighborhood school. The criterion for enrollment of students to another school is based on the date and time the student completes registration. If it becomes necessary to transfer a student, the last enrolled student will be the first student moved to another school. All students transferred to another school will be enrolled in their neighborhood school at the beginning of the following school year. If your student is transferred, it will be the responsibility of the parent/guardian to transport the child to the overflow school. Thank you for your understanding and cooperation. Sincerely, Marsha Gilbert Assistant Superintendent

_____ . . ____ . . ____ . . ____ . . ____ . . ____ . . ____

I acknowledge that I have received information regarding the potential “overflow” of my child due to enrollment at my neighborhood school or school requested under permit provisions. The process for overflow has been explained to me.

Parent’s Name(s) (please print) ______________________________

Home School (permit school) _______________________________

Child’s Name (please print) _________________________________

Parent Signature __________________________________________

Date ___________________________________________________

“EQUAL OPPORTUNITY EMPLOYER”

AUSD
English Health History
AUSD
Spanish Health History
AUSD
Chinese Health History

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