Student Information
Legal Name from Birth Certificate
**First Name: Middle: **Last:
**Date of Birth: mm/dd/yyyy
**Gender:
Preferred First Name:
**School:
**Previous School:
School Name:
City:
State:
**Grade Level:
**Anticipated Start Date:
Current Special Programs IEP 504 ELL
Guardian Information
**First Name: **Last Name:
**Relationship to Student:
Other Students in Family: Check this box if other members of your family are active students at schools in this district
**Desired User Name: Desired User Name for PowerSchool Login
**Email:
**Phone: 999-999-9999      Alternate Phone: 999-999-9999
**Street:
**City:
**State:
**Zip Code:
**Verification: I verify that the above information is correct
** Required Information