PRE-ENROLLMENT FORM

Columbus East High School

STUDENT INFORMATION
Name:	Social Security Number:	- -
New Address:
Zip Code:	Phone Number: ( ) -
Age:	Birth Date:
Race:	Current Grade:
School Previously Attended:
Address of School:
City & State: ,
Was the school state accredited: YES	NO
Was the student involved in any special programming (ie Learning Disabled)? YES	NO
If yes, what special program:
Reason for leaving previous school:
Was the student in good standing?	YES	NO
If no, specify the conditions:
Did the student take the ISTEP (GQE) Test?	YES	NO
Did the student pass the ISTEP Language Arts section?	YES	NO
Did the student pass the ISTEP Math section?	YES	NO
Does the student plan to participate in high school athletics?	YES	NO
(PLEASE CONTINUE TO PAGE TWO)

PRE-ENROLLMENT FORM

(continued)

Columbus East High School
PARENT/GUARDIDAN INFORMATION
Name of person(s) with whom the student will reside:
Relationship:
Place of employment:
Work Number: ( ) -
PARENT/GUARDIAN INFORMATION (CONTINUED)
Place of employment (spouse):
Work Number: ( ) -	Emergency Number: ( ) -
Emergency Number: ( ) -
Birth Certificate as required by Senate Enrolled Act 416(	Included	30 day limit
Immunization Records((((((((((((((((	Included	20 day limit
Copy of transcripts from sending school((((((((	Included	Not Included
I have reviewed the above information and find it to be accurate. I also realize that any false information will invalidate this enrollment.
Parent/Guardian Signature:
OFFICE USE ONLY
Entry Date:
Entry Type: Conditional	Permanent
If Conditional:
Birth Certificate

Immunization Records

Transcripts

Proof of Residence

Other
Was student handbook issued?	Yes	No
Was an IHSAA transfer form issued?	Yes	No
Mrs. Wohlfords’s Signature:
Date:

COLUMBUS EAST HIGH SCHOOL - 4/12/2009

PRE-ENROLLMENT FORM

Augie Doggie

2009-04-05

DaDogs