GREENVILLE COUNTY SCHOOLS
STUDENT ENROLLMENT FORM
STUDENT INFORMATION
______________________ ______________________
______________________
___________________
Last Name
First Name
Middle Name
Nickname
_________
_________
___________
_____________
________________
__________________
Grade
Gender
Birth Date
Enrollment Date
Place of Birth
SSN (for state verification)
Ethnic Code:
_____Asian
_____American Indian
_____White/African American
_____African-American
_____Hawaiian-Pacific Islander
_____White/American Indian
_____African Amer/Amer Indian
_____White
_____Other
_____Hispanic
_____White/Asian
_____________________________________________________________________________________________________
Name & Address of School Last Attended
TRANSPORTATION:
Arrival:
_____Car
_____Walk
_____Bus
_____Day Care Bus
_____Other___________________
Departure:
_____Car
_____Walk
_____Bus
_____Day Care Bus
_____Other___________________
ENGLISH PROFICIENCY:
_____Unknown _____Waiver _____LEP _____LEP Mainstreamed _____Exited _____English Speaker
BIRTH COUNTRY:_________________________________
MEALS:
_____Free
_____Reduced
_____None
MIGRANT:
_____Yes
_____No
FOSTER HOME:
_____Lives in Foster Home
_____Does Not Live in Foster Home
Student Lives with_____________________________________________________________________________________
Does student have any physical problems that may affect school attendance? _____________________________________
_____________________________________________________________________________________________________
List any special programs/services received at previous school. _________________________________________________
____________________________________________________________________________________________________
FAMILY INFORMATION
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______________________________
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