Student Enrollment - Murphy ESD

Murphy Elementary School District

Student Enrollment

Español

Welcome! Please fill out this enrollment form. You will need to bring specific documents to complete your registration.

School

School *

How did you hear about us?

Student Information

Student Last Name * Student First Name *

Student Middle Name Grade *

Sex * Date of Birth *

State of Birth

Country of Birth

Residency Information

Residential Address * Apt #

City * State * Zip Code *

School History

Has the student attended Murphy District before?

Has the student previously attended school the US?

Attended preschool / Head Start?

Last school attended Grade level at last school

Custody / Living Situation

Student custody Is the current address only temporary?

Is there a court-ordered custody arrangement?

Entry date to the U.S. (if not born in the U.S.)

Status (select all that apply)

Refugee Migrant Immigrant

Demographics

Is the student Hispanic/Latino?

Race (select all that apply)

Asian African American White American Indian/Alaska Native Native Hawaiian/Pacific Islander

Does your family claim American Indian tribal affiliation?

Siblings

Do you have other siblings attending or enrolling in Murphy ESD?

Transportation

Parent/Guardian

Parent/Guardian Name * Home Phone Cell Phone *

Work Phone Email *

Additional Parent/Guardian (optional)

Additional Parent/Guardian Name Additional Parent/Guardian Email

Additional Parent Home Phone Additional Parent Cell Phone Additional Parent Work Phone

Emergency Contact

Emergency contacts must be 18 years or older.

Emergency Contact 1

Contact Name * Relation *

Contact Phone *

Emergency Contact 2

Contact Name * Relation *

Contact Phone *

Emergency Contact 3

Contact Name * Relation *

Contact Phone *

Home Language

Primary language spoken at home

What language do people speak in the home most of the time? *

What language does the student speak most of the time? *

What language did the student first speak or understand? *

Discipline History

Has the student been expelled?

Has the student been suspended more than 10 days?

Attest

Enrollment Type * Murphy School District Resident Open Enrollment (non-resident)

I certify that all information provided is true and accurate. *

Typed signature (full name) *