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STEWART COUNTY SCHOOLS

STUDENT DATA FORM

  

(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: ________________________________________________________________