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District 34 Registration, Residency and Health Forms
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2023-2024 New Student Application
You must have JavaScript enabled to use this form.
NOTE: This form is for
NEW
students who have never attended a District 34 before.
To register students
RETURNING
to District 34, please login to
PowerSchool
using your parent account and use the Registration link within.
School
-Select-
Westbrook (K-2)
Lyon (K-2)
Henking (K-2)
Glen Grove (3-5)
Hoffman (3-5)
Pleasant Ridge (3-5)
Attea (6-8)
Springman (6-8)
Screening
Is your student in need of interpreting for the screening?
Yes
No
If Yes, in what language?
Information message
Use the
school lookup tool
if unsure what school boundary you live in.
Student Last Name (as it appears on birth certificate)
PLEASE DO NOT USE ALL CAPS
Student First Name (as it appears on birth certificate)
PLEASE DO NOT USE ALL CAPS
Student Middle Name
PLEASE DO NOT USE ALL CAPS
Lineage
Select if Applicable
Junior (Jr)
Senior (Sr)
the First (I)
the Second (II)
the Third (III)
the Fourth (IV)
the Fifth (V)
the Sixth (VI)
the Seventh (VII)
the Eighth (VIII)
Gender
-Select-
Male
Female
Non-Binary
When would you like your child to start school?
- Select -
First Day 23-24
Today
Other
If Other, Please Specify Date
Information message
Final start date will be determined upon completion and approval of Registration and Residency.
You will be notified once a start date has been set.
Date of Birth
Based on DOB entered, your student will be in grade:
Kindergarten Choice
Full Day Kindergarten
$3600 fee, or apply for fee waiver (
click here for waiver details
)
Half Day Kindergarten
$127 fee
Is the student Hispanic or Latino?
Yes
No
What is the student's race? (Check all that apply)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian/Other Pac Islander
White
Custody
-Select-
Both Parents
Mother Only
Father Only
Other
If other, please specify
Primary Phone
Format: (555)555-5555
Additional contact phone numbers can be added during the registration process after your application has been approved.
Email Address
This email will be used to communicate about the status of your application.
Additional contact emails can be added during the registration process after your application has been approved.
Home Address
Street
Apt#
Do not include "#", "Unit", etc
City
State
-Select-
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Are you currently participating in a federal assistance program such as SNAP (Supplemental Nutrition Assistance Program), TANF (Temporary Assistance to Needy Families), Medicaid or foster care?
Yes
No
Has This Child Ever Received Special Services?
Yes
No
Please indicate services received
IEP
504 Plan
Intervention
Reading Support
Private OT/PT/Speech
Enrollment Type
Transferring in from another school district in the US
Original entry into a US school
Documents Request
I authorize District 34 to request student records from my student's previous district
Last School Attended
Last School City
Last School State
