Student Enrollment Form 2020-2021

Please complete the form below. Required fields marked with an asterisk *

Grade Entering/Grado de entrada

Answer Required

Student Name/Nombre del Estudiante*

Answer Required

Sex*

Answer Required

Male

Female

Date of Birth/Fecha de nacimiento*

Answer Required

Country & State of Birth/Pais y Estado natal*

Answer Required

Student Address

Street Address

Answer Required

City

Answer Required

Zip/Postal

Answer Required

Phone Number*

Number Required

Names of ALL Siblings Requesting Enrollment (list grade)/Nombres de hermanos as que se matricularan en NWEC (escriba el grado)

Answer Required

Parent Contact Information # 1

First Name*

Answer Required

Last Name*

Answer Required

Email 1*

Answer Required

Mobile Phone*

Number Required

Home Phone

Number Required

Work Phone

Number Required

Parent Contact Information # 2

First Name*

Answer Required

Last Name*

Answer Required

Email 1*

Answer Required

Mobile Phone*

Number Required

Home Phone

Number Required

Work Phone

Number Required

Friend/Relatives Permission to Pick-Up/Amigos/familiares con permiso para recoger

First Name

Answer Required

Last Name

Answer Required

Mobile Phone

Number Required

Friend/Relatives Permission to Pick-Up/Amigos/familiares con permiso para recoger

First Name

Answer Required

Last Name

Answer Required

Mobile Phone

Number Required

Please answer the following questions.*

Answer Required

Yes

Has this student ever been expelled or in the process of being expelled from a previous school?/Ha sido, alguna vez, expulsado o en el proceso de tal, el estudiante mencionado?

Yes

Has this student been certified as having a chronic health problem?/Tiene algun problema cronico de salud?

Yes

Are there psychological or confidential reports available from the previous school?/Hay reports sicologicos o confidenciales disponibles de la escuela anterior?

Yes

Military Student Identifier - Please check one of the following*

Answer Required

Student is a dependent of a member of the United States military service on "Active Duty"

Student is a dependent of a FULLTIME member of the National Guard or Reserve force of the United States military

Student is a dependent of a member of the National Guard or Reserve force of the United States military

None of the above

Is the student Hispanic/Latino? (choose only one)/Es el estudiante Hispano/Latino? (Escoja solo uno)*

Answer Required

No, not Hispanic/Latino / No es Hispano/Latino

Yes, Hispanic/Latino / Si es Hispano /Latino

If the answer to the above question is yes, Please select "White" for the question below. What is the student's race?/Cual es la raza del estudiante?*

Answer Required

American Indian or Alaskan Native/Indio Americano o native de Alaska

Native Hawaiian or Other Pacific Islander/Nativo de Hawaii u otra isla del Pacifico

Black or African American/Negro o Afro-Americano

Asian/Asiatico

White/Blanco

Please fill out the following information, if it does not apply please write "N/A". / Por favor Ilene la siguiente informacion, si esto no se refiere a su hijo escriba "N/A".

Does your child have any health conditions?/Tiene su hijo/a alguna condicion de salud?*

Answer Required

Does your child have allergies to medications or food?/Tiene su hijo/a alegias a medicamentos o alimentos?*

Answer Required

Does your child have asthma and what are the causes? / Tiene su hijo/a asma y cuales son las causas?*

Answer Required

Does your child take daily medications? / Su hijo/a toma medicamentos a diario?*

Answer Required

Dr. Name / Nombre de doctor

Answer Required

Phone Number / Telefono

Number Required

Please fill out the information below (Por favor de rellenar la información de abajo)*

Answer Required

As the parent/guardian, I certify that the information submitted is correct. (Como padre/guardian, confirmo que la información entregado en esta forma es correcto.)

Contact Information (Informacion de Contacto)

First Name (Primer nombre)*

Answer Required

Last Name (Apellido)*

Answer Required

Date (Fecha)*

Answer Required

New World Educational Center

Please fix the highlighted areas below before submitting.

Student Enrollment Form 2020-2021