OFFICE USE ONLYOffice Use Only • March 27th, 2013
Contract Type FiledMarch 27th, 2013Last Name: Birth Date: First Name: Place of Birth: Full Middle Name : Grade: Gender: Have you ever been a student in our district? Yes No If yes, last grade School Choice? 504 Plan? Yes No Individualized Educational Plan (IEP)? Yes No Foster Child? Yes No State Ward: Is there a Custody Agreement? YES or NOo Mother Only o Father Only▪ Father has shared custody ▪ Mother has shared custody▪ Father does not have shared custody ▪ Mother does not have shared custodyo Mother – Step Father o Father – Step Mother▪ Father has shared custody ▪ Mother has shared custody▪ Father does not have shared custody ▪ Mother does not have shared custodyo Guardian