EdOptions High School Enrollment Application
Grade:
Gender
9
10
11
12
Male
Female
Legal First Name:
Legal Middle Name:
Legal Last Name:
Street Address:
Apt #:
City:
State:
Zipcode:
Arizona
Mailing address is different from above:
Student Info.
Parent/Guardian Info.
Language Info.
Previous School Info.
Ethnicity:
White
African American
Hispanic
American Indian / Alaska
Pacific Islander / Asian
Other
If Other please specify:
Date of Birth:
Birth State:
Birth Country:
Select...
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Home Phone:
Student's Cell Phone:
Parent's Cell Phone:
Parent's Email:
Student's Email:
Mother's Maiden Name:
Student lives with:
Both Parents
Father
Mother
Guardian
Other
If other, please specify:
Father's Name:
Mother's Name:
Guardian's Name:
Street Address:
Apt #:
City:
State:
Zipcode:
Select...
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Contact Phone 1:
Contact Phone 2:
Contact Phone 3:
What is the primary language of the student?
English
Spanish
Other:
Last School Attended:
Grade Level:
Year:
Previous School Attended:
Grade Level:
Year:
Previous School Attended:
Grade Level:
Year:
Has this student ever been expelled or suspended?
Yes
No
If Yes, what school?
Probation Officer:
Phone #:
Cell Phone:
Has this student received:
Special Education Services
Yes
No
Disability Classification:
Is IEP current?
Yes
No