Student Data Collection

Save & Return

OPTIONAL: Create an account or sign in to return to saved work.

Student Information:

School *

WVEIS Number 🛈

Homeroom Teacher

The following student information MUST match student's birth certificate.

Student FIRST Name: *

Student MIDDLE Name:

Student LAST Name: *

Preferred Name (if different from legal name)

Gender *

Male

Female

Date of Birth: MM-DD-YYYY * +

City of Birth *

State or Country of Birth *

Transferred from 🛈

Grade (2023-24 school year) *

Expected High School Graduation Year (based on 2023-24 grade) * 🛈

We want to welcome your young student to Monongalia County Schools!

In order to finish preschool enrollment, you MUST call the Early Childhood department at 304-291-9210 extension 1750 to get the rest of the enrollment documents completed.

Your student will not be enrolled in preschool until those documents are finished. Thank you for your understanding and cooperation!

Native Language (first language spoken) *

Is the student Hispanic? *

Yes

No

From the racial categories below, mark one or more races with which the student identifies. *

AM Bus

PM Bus

AM Bus Alternate

PM Bus Alternate

Student has ___ years attending school in any state. *

Please list siblings or other students from the same household attending Monongalia County Schools:

Is this student new to Monongalia County Schools? *

Yes

No

PLEASE NOTE:
In addition to completing this form, it is important that you also contact your student's new school to ensure all enrollment steps are completed. Completing this form is an important component of new student enrollment but it is not enough by itself! *

I understand that I must contact my student's school directly to provide proof of age and residence and to complete his/her enrollment. Although I may attach electronic copies of these documents below, enrollment requires contact with my student's school. Parent/guardian initials: I understand that I must contact my student's school directly to provide proof of age and residence and to complete his/her enrollment. Although I may attach electronic copies of these documents below, enrollment requires contact with my student's school. Parent/guardian initials:

Confidential Information:

Welcome to Monongalia County!
You may submit other documentation for student enrollment with this form, which is more secure than email or text messages for electronic submissions of information.

If you only have some of these documents at this time, please attach them and continue with the form. We can work with you to obtain the rest of the documents. We understand that some of these documents may be difficult or impossible to obtain until social distancing requirements are relaxed.

The documents that will be required include:

2 evidences of residence address (e.g. utility bill, lease agreement, mortgage/deed, etc.)
immunization records (click here to view immunization requirements)
birth certificate
Current physician physical exam (Incoming Kinergarteners please follow this link for a form. Others may use their physician's general physical exam format.)
Current dental health exam (you may use this form)

Is there a current Order of Protection or No Contact Order which concerns this student? *

Yes

No

*

I understand that I must provide a copy of the above referenced Order of Protection or No Contact Order to the school office.

Parent/Guardian Information:

NOTE: Any Custody Restrictions Must Be Documented By A Court Order. A Copy Of Court Order Must Be Provided To The School Office.

Student lives with: *

Both parents

Mother

Father

Guardian

If student lives with a guardian, there may be resources available to help. Please provide more information (optional). You may select more than one.

grandparent(s)

other family member(s)

other other

Parent/Legal Guardian 1:

Title

FIRST name *

MIDDLE name

LAST name *

Relationship to student *

Email Address *

If you do not have an email address, you may obtain one for free in several ways. Here are a few links that can help you get started, but there are many excellent free email providers and these are not the only ones we can recommend.

Gmail: Very popular email from Google https://accounts.google.com/SignUp
Microsoft Outlook: Most similar to student school email https://www.microsoft.com/en-US/outlook-com/
iCloud: iPhone and Mac users may already have an iCloud address https://www.icloud.com/mail
Zoho Mail: More private, ad-free email and office apps https://www.zoho.com/mail/
Proton Mail: Highly private, many options including paid levels https://proton.me
GMX: Less known but well regarded https://www.gmx.com/

Yahoo and Hotmail emails are not encouraged because they are the least secure and are often blocked by our state/school email filter.

Home Address (NO PO Box) *

City *

State *

Zip *

Home Phone *

Unlisted?

Yes

Cell Phone

Mailing address is different from home address.

Mailing Address

City

State

Zip

Employer

Work Phone

Occupation

Parent/Legal Guardian 2:

Title

FIRST name

MIDDLE name

LAST name

Relationship to student

Email Address

Home Address (NO PO Box)

City

State

Zip

Home Phone

Cell Phone

Mailing address is different from home address.

Mailing Address

City

State

Zip

Employer

Work Phone

Occupation

Military Connected Status

Please check any duty status below that applies to a parent/guardian of the student: * 🛈

Emergency Information

Please identify person(s) other than parent or guardian who could be contacted in case you cannot be reached. Anyone who is authorized to pick up your child from school should also be listed.

Emergency Contact 1:

Name *

Relationship to Student *

Home Phone

Cell Phone

Notes

Emergency Contact 2:

Name

Relationship to Student

Home Phone

Cell Phone

Notes

Emergency Contact 3:

Name

Relationship to Student

Home Phone

Cell Phone

Notes

Emergency Contact 4:

Name

Relationship to Student

Home Phone

Cell Phone

Notes

Special Instructions:

EMERGENCY USE ONLY:

Physician *

Physician Phone *

Hospital Preference *

Medical Instructions

0/255 characters

White	Black
Asian	American Indian
Pacific