Student Information Survey - The College School

Student First Name:(Required)

Student Last Name:(Required)

Please select student's grade level:(Required)

Please provide student's birthdate:(Required)

Student's street address:(Required)

City:(Required)

State:(Required)

Zip Code:(Required)

Please indicate the school district the student lives in:(Required)

Parent/Guardian Information

Please indicate one Parent/Guardian's name:	Parent/Guardian's place of employment:	Preferred contact telephone number(s):	Preferred contact email address(s):	Actions

There are no Parents/Guardians.

Emergency Contact Information - The following individuals may pick up my child if parents/guardians cannot be reached.

Name	Relation	Cell Phone	Home Phone	Work Phone	Actions

There are no Emergency Contacts.

Name:

Relation:

Cell Phone Number:

Home Phone Number:

Work Phone Number:

Section Break

Please provide maternal grandparent name and address(es):

Please provide paternal grandparent name and address(es):

Demographic Information

Annually, every school in Delaware is required to report to the Delaware Department of Education student data by race and ethnicity categories that are set by the federal government. The DOE does not report individual student data to the federal government, but does report the total number of students in various categories in each school. These reports track changes in student enrollments. Please identify your child by ethnic group (either Hispanic/Latino or NOT Hispanic/Latino).(Required)

Hispanic/Latino

NOT Hispanic/Latino

Please identify your child by ONE or more racial groups (American Indian or Alaskan Native, Black or African American, Asian, Native Hawaiian or other Pacific Islander, White.(Required)

American Indian or Alskan Native

Black or African America

Asian

Native Hawaiian or other Pacific Islander

White

Does your child have any allergies?(Required)

Please list any allergies here:

Related Services: TCS offers families the opportunity to contract for related services in the areas of Speech/Language Therapy and Occupational Therapy. If you would like additional information about related services, please indicate below:

Speech/Language Therapy

Occupational Therpy

During the school year, we may show movies that will help teach particular topics, provide entertainment for rainy day recess, and on occasion for special classroom rewards. Please select ALL ratings that you approve (you may select multiple options).(Required)

PG-13

Permission to Walk and/or use Transportation: I give permission for my child to walk and.or use the University of Delaware bus service or to be transported in parent and/or staff vehicles to go on class trips within ths vicinity of The College School (i.e. Morris Library, Carpenter Sports Building, Student Center, Newark Library, etc.). There is no charge to use the University bus services or the Newark Uni-City bus system.(Required)

Transportation Agreement: The primary mode of transportation for my child to and from school is:(Required)

Name and phone number of district transportation:

Name and phone number of van/car service:

The following people are authorized to transport my child to/from school (please submit names and relationships):