• Nettleton School District

    2025-2026 Student Registration Form
  • Birthday*
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  • Gender*
  • Hispanic/Latino Ethnicity:*
  • Is this child in Foster Care?*

  • RACE - Please answer the following in accordance with standards issued by the US Department of Education.

  • PRIMARY RACE (Please Select only ONE).*
  • ADDITIONAL RACES (check all that apply):

  • PARENT/ GUARDIAN CONTACT INFORMATION

  • Parent/ Guardian 1

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  • Student Primarily Resides with this Guardian?*

  • Parent/ Guardian 2

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  • Student Primarily Resides with this Guardian?

  • Additional Student Information

  • Home Language Usage Survey

     

  • Has your child attended school in the United States?*

  • Parent Employment Survey

    Your child may qualify to receive free educational services. Please answer the following questions to help us determine their eligibility. If you answered yes to the question below, an education representative may contact you to help make this determination.

  • Have you, or a member of your family with whom you reside, moved in the past three years to another area (permanently or temporarily) in order to work primarily in agriculture? (summer/temporary moves count)*
  • If Yes, Please check the agriculture job(s) that you worked at when you moved to the new area.

  • Travel Information

  • Travel to School*
  • Travel from School*
  • Clear
  • Pre-School Participation*
  • Is this child a dependent of an active or reserve member of a branch of the United States Armed Services?*
  • Is this student a twin (or a triplet, quadruplet, etc.)?*
  • Student has my permission to attend local field trips*
  • If we are unable to contact you and your child needs immediate medical attention, physicians need your permission to proceed with any medical treatment. The parent/legal guardian will be responsible for all medical and/or transportation expenses incurred.*
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  • Does your chils have any of the following? Check all that apply

  • Emergency Information

  • Emergency Contact Information (Contacts Other Than Guardians to be Called in Case of Emergency) List names in Contact order from first to last.

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  • Can check the child out?*
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  • Can check the child out?
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  • Can check the child out?
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  • Can check the child out?

  • Please list all siblings currently enrolled in Nettleton Public Schools

  • New Students  / Transfer Students

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  • Has this child been expelled from school in any other school district or is the child a party to an expulsion proceeding?*
  • Has this child ever been retained in school?*
  • Has this child ever attended Nettleton Schools before?*
  • Services Received:
  • Does the child already have a SPED IEP/504 PLAN in place?
  • Has the child met the requirements of the Arkansas State Health laws necessary to enter school?

  • Digital Equity Survey

  • Does this student have internet at home?*
  • If there is no internet access, what is the reason this student does NOT have internetaccess?*

  • What type of internet access does this student have?*
  • Is the internet performance acceptable for learning activities?*
  • What type of device use most often to complete learning activities away fromschool?*

  • What is the source of this primary learning device?*

  • What are the students access to this primary learning device?

  • Additional Forms

  • Please be sure to complete the McKinney-Vento survey after submitting this form so we can better accommodate your needs. A link will be provided.

    If you have any questions about McKinney-Vento, please contact Mr. JD Walker at 870-910-7830, Extension 5119.

    Por favor, asegúrese de completar la encuesta de McKinney-Vento después de enviar este formulario para que podamos atender mejor sus necesidades. Se proporcionará un enlace.

    Si tiene alguna pregunta sobre McKinney-Vento, comuníquese con el Sr. JD Walker al 870-910-7830, Extensión 5119.

  • Clear
  • Date*
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  • Should be Empty: