KIPP Enrollment KIPP Enrollment Form for 2017-2018 School Year Student & Parent Information:Student's Name: First Last Address Address City/State/Zip Preferred Transportation:St. Ritas (5122 Churchward)43 & Alpha40th & AlphaDelta & Acacia25th & C25th & Market20th & Island17th & IslandSigsbee & LoganEvans & Logan47th & Market45th & T38th & Ocean View38th & NationalSampson & Harrison30th & Webster30th & Ocean View30th & Marcy30th & NationalParent Pick UpPublic TransportationGenderMaleFemaleEthnicity and Race:The Federal Government has revised the laws by which schools are required to report data pertaining to “Ethnicity” and “Race”. They have also changed the allowable reporting categories. In order for your application to be processed, you need to fill out this data.Ethnicity:*UnknownHispanic/LatinoNot Hispanic/LatinoEthnicity must be reported. You must use one of these 3 choices.Race:*WhiteBlack or African AmericanAsianNative American or Alaska NativeNative Hawaiian or other Pacific IslanderMultiple CategoriesRace UnknownIf you selected Hispanic/Latino, race can also be reported, but this is optional. If you selected either of the other two Ethnicity categories, you must also report your child’s race. You may only choose one race category.Date of Birth: MM DD YYYY PhoneBest point of contact. Shirt Size:Youth MediumYouth LargeYouth X-LargeAdult SmallAdult MediumAdult LargeAdult X-LargeEntering Grade:5th6th7th8thCurrent School:Parent/Guardian Name:Employeer:Work Number:Cell Number:Email: Emergency Contact Name: First Last Emergency Contact Number:Home Language Survey:Language Child Learned First English Spanish Other Language Child Speaks Most Frequently at Home: English Spanish Other Language Parents Speak Most Frequently to Child: Spanish English Other Language Child is Most Comfortable With: Spanish English Other Language Spoken Most at Home: Spanish English Other Special Education Information:Is your child currently receiving Special Education service?YesNoHas your child ever received Special Education Services?YesNoDoes your child have an active 504 Plan?YesNoAdditional Information:Highest Level of Education Completed by Either Parent:Some High SchoolHigh School GraduateSome CollegeCollege GraduateGrad SchoolHas student ever been suspended or asked to leave a school permanently?NoYesIf "Yes," please explain:Recruitment Information:How did you find out about KIPP Adelante?