ContractStudent Enrollment Form • January 6th, 2017
Contract Type FiledJanuary 6th, 2017For Office Use Only (Section In Gray) Student ID # Grade E1 Int enroll-this year R3 Transfer from another LEA Admission Date E2 Int enroll from non-NC school R5 Re-enroll Previous W1 Homeroom / Team R2 Transfer within Same LEA R6 Re-enroll Previous W2 Enrolling School Proof of ResidencyMore than 2 proofs may be required one) Rent/Lease AgreementPurchase Agreement USPS Official Change of Address Form Other Student Information Legal First Name Legal Middle Name Legal Last Name Preferred First Name Date of Birth Last School Attended Location-City, State Last School Phone No. Ethnicity (check one) Gender Male Female Primary Phone No. Hispanic Non-Hispanic Primary 911 Address Race (Check All Applicable) Street No. & Name Am Indian/Alaska Native City & Zip Code Native Hawaiian/Pacific Islander Black/African-American Mailing Address (if different from 911 Address) Asian Street No. & Name White City & Zip Code School Ag