Dodgeland School District - Student Enrollment Request Form

Please accurately complete and submit the following enrollment questions.

Contact Mrs. Pasewald at (920) 386-4404 x1001, or pasewald@dodgeland.k12.wi.us, if you have any questions.

3K play based program - Please contact Ms. Huelsman for information: (920) 384-4404 x1013.
4K - The student must be four years old on or before September 1st to enroll in 4K.
5K - The student must be five years old on or before September 1st to enroll in 5K.

1.

*

Do you live within the Dodgeland school district (will need to provide proof of residency, see website for details)?

Yes

No (I have Complete Open Enrollment)

No (I have NOT Complete Open Enrollment)

2.

*

If you do not live within the Dodgeland School District, have you been approved for open enrollment?

Yes

No

Not Sure

3.

*

Has your student previously attended Dodgeland?

Yes

No

4.

*

Student's Legal First Name (will need to show proof of identity, see details on website):

5.

*

Student's Legal Middle Name (will need to show proof of identity, see details on website):

6.

*

Student's Legal Last Name (will need to show proof of identity, see details on website):

7.

*

Date of Birth:

8.

*

Birth City, County, State, Country:

9.

*

Gender:

Male

Female

Non-Binary

10.

*

Student Address Street, City, State, Zip:

11.

*

Current School Year Grade Level:

12.

*

Current/Previous School Name, City, State:

13.

Primary Guardian First & Last Name:

14.

*

Primary Guardian Relationship:

Father

Mother

Step-parent

Other

15.

*

Primary Guardian Phone Number:

16.

*

Primary Guardian Home Address (Street, City, State, ZIP)

17.

*

Primary Guardian Email Address:

18.

Second Guardian First & Last Name:

19.

Second Guardian Relationship:

Father

Mother

Step-parent

Other

20.

Second Guardian Phone Number:

21.

Second Guardian Home Address (Street, City, State, ZIP)

22.

Second Guardian Email Address:

23.

Does this student have a sibling attending Dodgeland?

Yes

No

24.

What is the primary language spoken at home?

English

Spanish

Other

25.

*

Does this student have an active IEP (Individualized Education Plan)?

Yes

No

26.

*

Does this student have an active 504 plan?

Yes

No

27.

*

What is the anticipated start date?

Student Enrollment Request Form

Student Enrollment Request Form:

Please accurately complete and submit the following enrollment questions.