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New Student Information

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INSTRUCTIONS: This form is to be completed by parent/guardian or eligible Student . For all students new to or reentering MCPS, the verification of the following must be presented at the time of enrollment: Montgomery County residency, age and immunizations, unless INFORMATIONMust match birth certificate or other evidence of birthLegal Last Name ______________________________________ Legal First Name____________________ Legal Middle Name____________________Student s Identified First Name ________________________________________ ________________________________________ ____________________ Birthdate _____/_____/______ Gender o M (Male) o F (Female) o X (unspecified/non-binary)

o Maryland Department of Health Immunization Certificate 896 o Computer form generated by a physician or health clinic o Other _____ ETHNICITY 1. ETHNICITY DESIGNATION. Read the definition below and check the box that indicates this student’s heritage. ... *ESOL—English for Speakers of Other Languages/ESL—English as a Second Language/ENL ...

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