First Name:
Last Name:
Address 1:
Address 2:
City:
State/Province:
Zip Code:
Home Phone:
Entry Date (MM/DD/YYYY):
Entry Type:
Choose One
(1) - Transfer from another BSSD school
(2) - Transfer from a public school in a different school district in Alaska
(3) - Transfer from a public school in a different state or country
(4) - Transfer from home schooling
(5) - Transfer from a private school
(6) - Transfer from an institution with an educational program
(7) - Re-Entry after a voluntary withdrawal from same school
(8) - Re-Entry after a explusion from same school
(9) - Student is new to the school
(10) - Student continuing from last year
Transfer from a BSSD School?:
Choose One
No - See Entry Type
Brevig Mission
Diomede
Elim
Gambell
Golovin
Koyuk
Savoonga
Shaktoolik
Shishmaref
St. Michael
Stebbins
Teller
Unalakleet
Wales
White Mountain
Transfer from another Alaskan school district?:
Choose One
No - See Entry Type
Alaska Gateway
Aleutian Region
Aleutians East Borough
Alyeska Central Correspondence
Anchorage
Annette Island
Bristol Bay Borough
Chatham
Chugach
Copper River
Cordova
Craig
Delta/Greely
Denali Borough
Dillingham
Fairbanks
Galena
Haines
Hydaburg
Iditarod Area
Juneau
Kake
Kashunamiut
Kenai Peninsula
Ketchikan Gateway
Klawock
Kodiak Island Borough
Kuspuk
Lower Kuskokwim
Lower Yukon
Mat-Su Borough
Mt.Edgecumbe
Nenana
Nome
North Slope Borough
Northwest Arctic Borough
Pelican
Petersburg
Pribilof Islands
Saint Mary's
Sitka Borough
Skagway
Southeast Island
Southwest Region
Tanana
Lake & Peninsula
Unalaska
Valdez
Wrangell
Yakutat
Yukon Flats
Yukon Koyukuk
Yupiit
Other - Distance Learning
Other - Juvenile Corrections
Other - Residential Treatment
Transfer from another state or country?:
Choose One
No - See Entry Type
Yes
If another state or country, where is student from?:
Person Enrolling Student:
Choose One
School Secretary
Counselor
Principal
Your Email Address::
Date of Birth (MM/DD/YYYY):
Testing Level:
Choose One
PK - 3 year-old
PK - 4 year-old
K
1
2
3
4
5
6
7
8
9
10
11
12
Gender:
Choose One
Male
Female
Shot Record On File?:
Choose One
No
Yes
Transcripts Requested?:
Choose One
No
Yes
Is this a Special Education student?:
Choose One
No
Yes
Don't Know
If YES, have Special Ed records (including discipline files) been requested from sending school?:
Choose One
Yes
No
Not Sure
Alaska Student ID::
BSSD Student ID::
Ethnicity:
Choose One
Alaska Native
Caucasian (White)
Black (Not Hispanic)
Hispanic
Asian or Pacific Islander
American Indian
Other
Schedule / Level Request Submitted?::
Choose One
Yes
No
What are levels?
Comments: