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I.C.S. Enrollment Application -2022/2023
Date of Application
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What grade level is your child?
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6 Grade
7 Grade
8 Grade
9 Grade
Date of birth
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Place of Birth:
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Student Name
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Last Name
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MI
Gender
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Male
Female
Student ID
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Social Security #:
Did student previously attend an ORANGE COUNTY SCHOOL?
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Yes
NO
Residential Address
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Apt
City
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State
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Zip / Post Code
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Email Address
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Home Phone
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Cell Phone
Race/Ethnicity
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African American
Asian
Caucasian
Hispanic
Native American
Other
Residence Status
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US Citizen
Not US Citizen
Native Language
If “no”, date of entry into the USA
City
State
Primary Guardian Student lives with
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both parents
one parent
shared custody
Other
Parent/Guardian Name
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Work Phone:
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Cell/Other :
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Occupation/Title:
Email Address
*
How will your child get to school?
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walk
city bus
car rider
Upload Photo ID:
Parent/Guardian Signature
*
clear
EMERGENCY CONTACT INFORMATION:
First Name:
*
Last Name:
*
Relationship to Parent:
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Address:
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Apt:
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City
*
State
*
Phone
*
Email Address
*
Upload Photo ID: