Student Enrollment Form Application

Mitchell County School System (MCSS): Student Enrollment Form

Please complete the form below for each new student enrolling in the Mitchell County School System.

Student's Last Name:

Answer Required

Student's First Name:

Answer Required

Student's Middle Name:

Answer Required

Student's Date of Birth:

Answer Required

Gender:

Answer Required

Male

Female

Race/Ethnicity:

Answer Required

African American

Caucasian

Hispanic

Asian

Other

1. Which language does your child best understand and speak?

Answer Required

Which language does your child most frequently speak at home?

Answer Required

In which language would you prefer to receive all school information?

Answer Required

Parent First Name

Answer Required

Parent's Last Name

Answer Required

Email 1

Answer Required

Mobile Phone

Number Required

Address

Street Address

Answer Required

City

Answer Required

Zip/Postal

Answer Required

If your child is transferring from another school, fill out the information below.

List the name of the school district.

Answer Required

Name of the school and the city and state the school where the school is located.

Answer Required

Parents: if possible please mail a copy of your child's immunization record, social security card, Ear-Eye-and Dental Form and birth certificate and Proof of Residency to:

Lori Brinkley

Mitchell County Board Office

108 South Harney Street

Camilla, GA 31730

take a picture of the document and email it to her at lori_brinkley@mitchell.k12.ga.us

Parent Occupational Survey Section: Please complete the following questions to dertermine if your child(ren) qualify to receive supplemental services under Title I, Part C.

Has anyone in your household moved in order to work in another city, county, or state in the last 3 years?

Answer Required

Yes

Has anyone in your household been involved in one of the following occupations, either full or part-time or temporarily during the last 3 years?

Answer Required

Yes

If you answer "yes", check all that applies:

Answer Required

Planting/picking vegetables (tomatoes, squash, onions, etc.) or fruits (grapes, strawberries, blueberries, etc.)

Planting, growing, cutting, processing trees (pulpwood) or raking pine straw

Processing/packing agricultural products

Dairy/poultry/livestock

Packing/processing meats (beef, poultry, or seafood)

Commercial fishing or fish farms

Other

Mitchell County Schools

Please fix the highlighted areas below before submitting.

Student Enrollment Form Application