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Union-Endicott CSD New Student Registration Form

Union-Endicott Central School District

Central Registration: 1100 East Main St, Endicott NY 13760 - 607-757-2346 or 607-757-3212

Welcome to the Union-Endicott Central School District,

The online registration process will give us the initial information we need to enroll your student. During this process you will be asked to securely upload the following documents that are needed for registration:

Proof of Birth (Birth Certificate or Passport)
Two proofs of residency in Union-Endicott (Board Policy 7130)
Parent/Guardian photo identification
Immunization records Required Immunizations
Custody papers (if applicable)

*If you have any question please contact registration at 607-757-2346 or 607-757-3212

Thank you for enrolling at the Union-Endicott Central School District!

Primary Parent/Guardian

Primary contact's first name *

Primary contact's last name *

Middle Initial

Primary contact's street number *

Primary contact's street name *

Primary contact's Unit/Apt/Lot number

Primary contact's city *

Primary contact's State *

Primary contact's ZIP code *

Mailing Address

Home Phone *

Primary contact's cell phone number *

Work Phone

Primary contact's email *

Primary Parent/Guardian Permissions *

Receives Mail
Parent Portal (must have valid email)
Can Pick Up Student

Spouse or Other Adult in the Home

First Name *

Last Name *

Middle Initials

Resident Address *

Does your address need to remain confidential? *

Yes

Mailing Address

Home Phone *

Cell Phone

Work Phone

Email *

Spouse or Other Adult in Home Permissions *

Receives Mail
Parent Portal (must have valid email)
Can Pick up student

Student Information

Student's last name *

Student's first name *

Student's middle name *

Students Date of Birth *

Hispanic *

Yes

Student's gender *

Student's race: *

Primary contact's relationship *

Spouse/Other Adult in the home is: *

Does your child have:

IEP

504 Plan

Medicaid

If Medicaid chosen, what is the ID#:

Union-Endicott ReEntry? *

Yes

If Yes, building last attended:

Ann G. McGuinness (AGM)
Charles F. Johnson Jr. (CFJ)
George F. Johnson (GFJ)
Thomas J. Watson (TJW)
Jennie F. Snapp Middle School (JFS)
Linnaeus W. West Tiger Ventures (LWW)
Union Endicott High School (UEHS)

Student ID# (If Known)

Siblings:

Last Name	First Name	Middle initial	Date of Birth	Age	Gender	Indicate IEP, 504, or NONE

Emergency Contacts:

Last Name	First Name	Address	Phone number	Relationship to student

Last School Attended

District Name

School Name

School Address

School Phone

School Fax# or Email

Primary Language *

Is there anything you would like us to know about this registration? (Homeschooling, special circumstances, etc.) *

Participant Acceptance *

I understand that statements made in this form will be relied upon by the Union-Endicott Central School District. I swear/affirm that these statements are true under penalty of perjury, and I understand that filing of a false instrument and the theft of services from a government agency such as a school district may be punishable by New York State law. I further Acknowledge that making false statements in this affidavit may subject me to criminal prosecution.

I authorize the release of all information to school personnel (academic, health, and confidential) for the student whom I am registering in Union-Endicott Central School District.

Name

Submission Public, please sign Show me how

Clear

Proof of Birth *

List of Allowed file types

First Proof of Residency *

List of Allowed file types

Second Proof of Residency *

List of Allowed file types

Valid NYS Driver License or ID

List of Allowed file types

Immunization Records

List of Allowed file types

Custody agreement (Full Document, if applicable)

List of Allowed file types