EmailMe Form - New Sepulveda Student Form

1) Parent/Guardian Name *

First Last

2) Student Name *

First Last

3) Student Birthday *

MM / DD / YYYY

4) Home Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

5) Proof of Residence (Utility service contract, bills (gas, water, electric), property tax, current pay stub, office government mail (CalWorks, Social Security, Medi-cal) *

6) Parent/Guardian Identification (Current Driver's License or Identification, Consular Identification) *

7) School records (report card, Individual Education Plan (IEP), pupil records)