Bilingual Program Enrollment Form

Bilingual Program Enrollment Form
Please complete this form to enroll your child in the bilingual program. All information will be kept confidential.
Student Full Name*
First NameLast Name
Student Date of Birth*
MonthDayYear
Date
Current Grade Level*
Home Address*
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Parent/Guardian Full Name*
First NameLast Name
Parent/Guardian Email Address*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Primary Language Spoken at Home*
EnglishSpanishMandarinFrenchOther
Student's Proficiency in Each Language*
Rows Beginner Intermediate Advanced
English
Spanish
Mandarin
French
Other
EnglishSpanishOther
Emergency Contact Name*
First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
Please share any additional information or special considerations for your child's enrollment.
Should be Empty: