EmailMeForm
Scottsbluff Public Schools New Student Enrollment
Please fill out the following as completely as possible.
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The student resides in Scottsbluff
*
Yes
No
School Year Student is Enrolling In
*
2022-2023
2023-2024
School Student is Enrolling In
Please select
Lake Minatare
Lincoln Heights
Longfellow
Roosevelt
Westmoor
Bluffs Middle School
Scottsbluff High School
If you are unsure of your school district boundary, leave blank and a staff member will check your address
Grade
*
Please select
K
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2
3
4
5
6
7
8
9
10
11
12
Please choose the grade your student will be in for the school year you are enrolling in
Student Name (legal)
*
First
Middle
Last
Suffix
Student Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Please select
Male
Female
Ethnicity (Must Choose One)
*
Hispanic/Latino
Not Hispanic/Latino
Race (Check all that apply, must choose one regardless of ethnicity)
*
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Student Lives With (check all that apply)
*
Father Only
Father/(legal) Stepmother
Mother Only
Mother/(legal) Stepfather
Each Parent Separately
Both Parents
Other
Household 1
Parent/Guardian Information
Parent Name (legal)
*
First
Middle
Last
Suffix
Parent or Guardian
*
Yes
No
Parent Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Please select
Male
Female
Email Address
*
Confirm Email
Relationship to Student
*
Cell Phone
*
###
-
###
-
####
Work Phone
###
-
###
-
####
Employer
Ethnicity (Must Choose One)
*
Hispanic/Latino
Not Hispanic/Latino
Race (Check all that apply, must choose one regardless of ethnicity)
*
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Parent Name (legal)
First
Middle
Last
Suffix
Parent or Guardian
Yes
No
Parent Date of Birth
MM
/
DD
/
YYYY
Gender
Please select
Male
Female
Email Address
Relationship to Student
Cell Phone
###
-
###
-
####
Work Phone
###
-
###
-
####
Employer
Ethnicity (Must Choose One)
Hispanic/Latino
Not Hispanic/Latino
Race (Check all that apply, must choose one regardless of ethnicity)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Residential Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Mailing Address if Different
Street Address
City
State / Province / Region
Postal / Zip Code
Complete the Following for Step-Parent ONLY
Authorized to access educational records
Yes
No
Authorized to pick up/call in student
Yes
No
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