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
2 digit month, 2 digit day, 4 digit yearDate
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
Secondary Language(s) Spoken at Home
Other
Student's Proficiency in Each Language
Rows Beginner Intermediate Advanced
English
Spanish
Mandarin
French
Other
Preferred Language of Communication for School Notices
Other
Emergency Contact Name
First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Is your child currently enrolled in any language support or special education services?
Please share any additional information or special considerations for your child's enrollment.
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