Parents: Please complete back of form (page 2)
Teacher: check one:
 No-show First Day
OR
REGISTRATION FORM – NEW STUDENTS
Please complete front AND
BACK of this page.
CLEVELAND INDEPENDENT
SCHOOL DISTRICT
OR  Present First Day And Teacher Initials _____
Office
Use
Only
Entry Date: ____________________
Grade: _____ Homeroom: _______
Campus: _________________________________________________________
Student Name (legal): _________________________________________________________________________________________
Last
First
Middle
Sex: _________ Birth Date: _______________________ Student ID: _____________________ SSN #: ________________________
Student resides with:  mother
 father
 both
 other ___________________________________________________
Mother/Guardian: ________________________________________ Phone: (home) ___________________ (work) ______________
Father/Guardian: _________________________________________ Phone: (home) ___________________ (work) ______________
Guardian Email Address: _______________________________________________________________________________________
Student’s Physical Address: ____________________________________________________________________________________
Street Address
City
Zip
Student’s Mailing Address: _____________________________________________________________________________________
Street Address
City
Zip
Other Parent/Guardian Email Addresses: __________________________________________________________________________
Warning: It is a criminal offense pursuant to Texas Penal Code 37.10 for a person to knowingly falsify information on a form
required for a student’s enrollment in the District. This is such a form.
Parent/Guardian Signature Required for Enrollment of Students
Si es necesario por favor pedir la forma en español.
I am aware that in order for my child to attend school in the Cleveland ISD, my child must meet the district's residency requirements. I acknowledge that I have read
and understand the penalties of falsified information as stated in the Texas Education Code §25.001(h) printed below. I also agree to inform the proper school
authorities immediately, should I move from the address indicated. Proof of residency is required.
Texas Education Code. §25.001
h. In addition to the penalty provided by §37.10 of the Penal Code, a person who knowingly falsifies information on a form required for enrollment of a student in a
school district is liable to the district if the student is not eligible for enrollment in the district but is enrolled on the basis of the false information. The person is liable,
for the period during which the ineligible student is enrolled, for the greater of:
1) the maximum tuition fee the district may charge under §25.038 of this code; or
2) the amount the district has budgeted for each student as maintenance and operating expenses.
I hereby certify one of the following: a)primary guardian is a resident (managing conservator or legal guardian/s), b)other legal parent is a resident (possessory
conservator), c)student signing form is at least 18 years of age and a resident of the district. I understand that one of these conditions must be maintained in order
for the student to attend the Cleveland ISD. I also agree to inform the proper school authorities immediately, should I move from the address indicated above.
With my signature I acknowledge that I have read and verify the information on this registration form, and that I understand the penalties of providing falsified
information as stated above.
_______________________________________________________________
Parent/Guardian Signature
_________________________________________________________
Date
In order to meet Texas Education Agency's recommended guidelines, CISD is using social security numbers for the required PEIMS Reporting Number. If you choose
not to provide this information, please provide the District's administrative office with written objection within ten days of the issuance of this notice.
The Cleveland Independent School District does not discriminate on the basis of race, color, national origin, sex, religion, age, or disability in its admissions policies, or by
excluding from participation in, denying access to, or denying the benefits of district services, academic and/or vocational and technology programs, or activities as required by
Title VI and Title VII of the Civil Rights Act of 1964, as amended, Title IX of the Education Amendments of 1972, the First Amendment of the United States Constitution, the Age
Discrimination Act of 1975, Section 504 of the Rehabilitation Act of 1973, as amended, and Title II of the Americans with Disabilities Act.
For information about Title IX rights, contact the Title IX Coordinator, 316 East Dallas, Cleveland, Texas 77327; (281) 592-8717. For information about Section 504/ADA rights,
contact the Section 504/ADA Coordinator, 316 East Dallas, Cleveland, Texas 77327; (281) 592-8717.
Parents should forward any medical information, allergies, or medical problems to the attention of the campus.
Administrative Enrollment: ______________________________________________________________ __________________
Administrator or Diagnostician/Speech Therapist’s Signature/Title
Date
front (page 1)
Cleveland Independent School District (146901)
Office Use Only
________________________________________________________
Campus Name
Student’s Legal Name __________________________________________________________________
________________________________________________________
Campus Number
Please fill out the following information for all schools in which this student was previously enrolled.
________________________________________________________
Student ID#
Name of School
Name of School District or City &
State in which School is Located
School Telephone #
Date(s) of Enrollment
Grade(s)
Student’s Address While Attending This School
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