Submit Census Information

Student Information

Student Last Name
Student First Name Student Middle Initial Student Birth Date

Student Gender Required

Gender:

M

F

Student Hispanic Y/N Required

Hispanic:

Yes

No

- New York State Education Department is now allowing parents to choose Hispanic/Latino ethnicity and multiple racial groups for their children. Please indicate Hispanic/Latino ethnicity with Yes or No and indicate your childâ€™s race by choosing one or more selection(s) in the race column listed below. New York State requires all students to have an ethnicity and at least one race selected.

Student Race Required (1 or more)

Name of School Attending Current Grade

Guardian Information

Guardian Last Name Guardian First Name Address City State Zip Primary Phone#

Cell Home

Secondary Phone#

Cell Home

Work Phone ext: Email Address

Gender:

M

F

Relationship to Student(s)

Student Information

Student #2 Information

Student #3 Information

Guardian Information

Guardian #2 Information