Student's Name:          Birthday:

Current Grade: Select One K 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th                                                Birthplace:

U.S. Enter Date:                    Enter Date U.S. School:

Enter Date CA School:            Last School Attended:

City, State:                           School District:

Enter Date CA School:            Telephone Number:

Fax Number:                         Contact Person:

Has your child previously attended any school in the AUSD?: Yes No

Current Alvord USD School of Residence:
           Elementary Select One Arlanza Collett Foothill La Granada McAuliffe Myra Linn Orrenmaa Promenade Rosemary Kennedy Terrace Twinhill Valley View   Middle Select One Arizona Loma Vista Villegas Wells   High Select One Alvord La Sierra Norte Vista

Parent/Guardian's Name:          Telephone Number:

Requested By:

Appointment Date:

Will you be in need of: Testing Service Translating Service Or both

What is the main language spoken at home:

Does your child know English?: Yes A little bit No

What time block would you like schedule your appointment? 8:00-10 a.m. 10:00 a.m.-12 p.m. 12-2 p.m. 2-4 p.m.

Is your child a Special Needs student.................? Yes No

Other Comments?