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General Student Demographics Form (Elementary)
General Student Demographics Form (Elementary)
Please complete the form below. Required fields marked with an asterisk *
Student LAST Name
*
Answer Required
Student FIRST Name
*
Answer Required
Student MIDDLE Initial
*
Answer Required
Student's Physical Address
Street Address
*
Answer Required
City
*
Answer Required
State
*
Answer Required
Please Select
Pennsylvania
Zip/Postal
*
Answer Required
Mailing Address (if different from physical address)
Answer Required
Home Phone Number
*
Number Required
Student's Date of Birth
*
Answer Required
Parent(s) or Legal Guardian's Name
*
Answer Required
The parents are
Answer Required
living in the same home.
separated.
divorced.
Which parent has legal, physical custody of the student?
*
Answer Required
If the student's parents/guardians are separated or divorced, are custody papers on file with the school?
Answer Required
Yes
No
Not applicable
Father's Name (First and Last)
Answer Required
Father's Preferred Phone Number
Answer Required
Father's Mailing Address
Answer Required
Father's Employer
Answer Required
Mother's Name (First and Last)
Answer Required
Mother's Preferred Phone Number
Answer Required
Mother's Mailing Address
Answer Required
Mother's Employer
Answer Required
Please list any siblings and include grade level if school aged.
Answer Required
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