YSLETA INDEPENDENT SCHOOL DISTRICT 071-905 (TEA Campusit ) 2013-2014 Enrollment Form, OFFICE USE ONLY: SSe. __ALT ST ID#, GRADE__CAMPUS. “Teacher(eem/Counselorcecondan) LOCAL ID ENTRY DATE )20__ WO DATE. 10_RE-ENTRY DATE__|__/20__Campus Residency _ ADA Elig Code: 1 (ude m-dsr)2 (at ay incite 3 (ul day outst) 4 (tl day nog (aay neg) 6 (aay ov csi) 0 (ero, notin nenbeship) | Pk only: AM _PM_Ful-Day Resbict Personal nfo___Next Year Campus__Bus Route. Locker Notarized Leer ALT POA GP | Student's Name (Nombre de! Estudiante): Last pono) First orto) Middle ‘Gen | Date of Birth (Fecha de Nacimora) Sex (Sexo: MF Home Phone (Teron) Tbe aes Ete cated on hovsing projec itary Noun, ran tid nd, mak he cation below ieee xt no dor ‘ge a8 of Sept tana ere ae Sd ‘ ) - pecs era casas popetdlralo mite bode una Ineomotie de nos ates anereas magi Bsec30N65 pea: ‘Students Address (Dono a Esa) ‘ante Zp Code (coon Post [OMILITARY COTRIBAL EHOUSING PROJECT (Los proyectos) Place of Birth (Cua Navnion): City, State (esas) Country Pa) Date Enrolled in US. Schools_J__/. School Last Attended. {Uma escela que asso Name of School ss Raressip Fee que prcipc grado Emergency Contact Person (Cor quien comuncarse an caso de omergencia7) 1, Relation (Parentsco 2. Relation (Parentesco Phone (Tesoro Phone (ron) ‘With Whom Does the Student Live: Both Parents Father CMother 'PARENTIGUARDIAN INFORMATION legal Guardian other (eon aio vio a estutant) (Arneos paces) — (Pate) (Matte) (TutorLega) (Ora Persona) Father/Guardian, Mother/Guardian, (Parenter (ataetutoy| Address, Address, (Domo) (ome) Phone. Ait. Phone (Cell). Phone. A Phone (Cell). {Totton (atstore) E-mail pos. E-mail pos. Employer Employer. (Lugar 60 omeee) (Lugar do oreo) Employer's Address, Employer's Address, (Domi de Emeo) (Pom de Ease) ‘Work Phone Work Phone. {Totoro de orice) (Tebtono ao ompeo) Does parenvguardian work on fe Does parentiguardian work on federal property? YES NO (2 Trabaan padres en propiedad federal?) (cTrabajn pasestutar en propeded federal?) 's parentguardian on Active Duty in the Uniformed Services? YES NO Is parent/guardian on Active Duty inthe Uniformed Services? YES NO (cee ef padra/Tutr acto ena serio mtr?) Military Rank Branch of Service (race) (Rome de Sort) Is pareniguardan an accredited foreign government oficial? YES NO Foreign County, Rank ‘ranch (Gero padre/Tter eta en el sei itr) itary Rank Branch of Service. (crac) (amo de Serio), {s parendguardian an acredtes foreign government oficla? YES NO Foreign County Rank ‘Branch [Name of person enrolling student (More de la persone que inscribe a estar) Parent/Guardian Signature. Adaress (omcio) 5 Date of Birth, (aca de Nacimona) Date WH Stock 00027 Revea 17272013,