Introduction Section

	First Name*	Middle Name	Last Name*
row 1	First Name*	Middle Name	Last Name*

Student Birth Date and Age

Student Date of Birth*
Current Age
Age(Sept 1)
* Metro E enrolls students beginning with grade KG(kindergarten - Age 5 on September 1.) through grade 6. Metro-Prep enrolls students in the 7th & 8th grades.
* A child who is younger than 5 years of age on September 1 is not eligible to attend Metro-E.
* Students who are age 5 on Sept. 1 are limited to grade KG
Grade This School Year*
Grade Next School Year*
This application is for Metro Elementary School of Design.
This application is for Miller Metro Prep Middle School
List any medical conditions or health concerns for this student.
High School Attendance Zone

Race and Ethnicity
The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff. This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC).
School district staff and parents or guardians of students enrolling in school are requested to provide this information. If you decline to provide this information, please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting
Please answer both parts of the following questions on the student’s or staff member’s ethnicity and race. United States Federal Register (71 FR 44866)
Ethnicity
Hispanic/Latino -A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
Is this Student Hispanic?*
YesNo
Select any Race(s) for this student*
American Indian or Alaskan NativeAsianAfrican AmericanWhiteNative Hawaiian/Other Pacific Islander

What language does the student speak most of the time?*
EnglishSpanish
Which of the following services has this student received
BilingualESL504DyslexiaGifted/TalentedMigrantSpecial EducationSpeechNo Services Received

Is this student the child of a full-time district employee?*
YesNo
The next question is in regards to Metro-Prep
The next question is in regards to Metro-E
Is this student a child of Metro employee?*
YesNo
Full time employee's Name
Full time employee's position
Full time employee's department
A question regarding to Miller Metro Prep Middle School
A question regarding to Metro Elementary School of Design
Does this student have siblings currently attending Metro?*
YesNo
Sibling 1 Name
Sibling 1 Grade
Sibling 2 Name
Sibling 2 Grade
If selected to attend Metro and your home is two or more miles from the school, will the child need transportation?*
YesNo
For the prior school year did your child attend a:
Private SchoolCharter SchoolHome SchoolPublic School
Where/How did you learn about Metro?*
Please provide the other information source where you heard about Metro?

Corpus Christi ISD is required to collect and report the socioeconomic status of each student to the Texas Education Agency for purposes of the annual state accountability ratings and for federal reporting. Please note that this form is not sent to the Texas Education Agency and that the income levels indicated for your family are not reported to the Texas Education Agency. Only the Economic Disadvantaged status of each student as determined by the information provided is reported to the Texas Education Agency.
In accordance with the provisions of the Protection of Pupil Rights Amendment (PPRA) no student shall be required, as part of any program funded in whole or in part by the U.S. Department of Education, to submit to a survey, analysis, or evaluation that reveals information concerning income (other than that required by law to determine eligibility for participation in a program or for receiving financial assistance under such program), without the prior written consent of the adult student, parent or legal guardian.
Does this student receive free or reduced lunch?*
YesNo
Do you receive Supplemental Nutrition Assistance(SNAP)?*
YesNo
Do you receive Assistance to Needy Families(TANF)?*
YesNo
How many members are there in this household(include all adults and children)?*
Total yearly income before deductions for all household members(select a range)?*

	First Name*	Middle Name	Last Name*
row 1	First Name*	Middle Name	Last Name*

	Street Address*	City*	State*	Zip Code(5-digit)*
row 1	Street Address*	City*	State*	Zip Code(5-digit)*

	Street Address	City	State	Zip Code(5-digit)
row 1	Street Address	City	State	Zip Code(5-digit)

	Street Address	City	State	Zip Code(5-digit)
row 1	Street Address	City	State	Zip Code(5-digit)

	Cell Phone	Home Phone	Work Phone
row 1	Cell Phone	Home Phone	Work Phone