Northwest Area School District

Online Student Registration System

Student Ethnicity- Please check all that apply *
If Multi-Racial is Selected, Please Select all that apply:
Sex *
Student Place of Birth
Has the student been a resident of Pennsylvania since birth? *
Has the student been a U.S. citizen since birth? *
Primary Physical Address
Primary Guardianship Information
Student lives with:
Primary Guardianship Information
Primary Guardianship Information (2)
Are there any custody documents on file regarding the guardianship of this student? *

Name of other siblings living in the home
Age of Sibling
Emergency Contact Information
Emergency Contacts
Relationship to Student
Phone 🛈
Student Enrollment Information
Has your child ever been enrolled in The Northwest Area School District? *
Has the student attended school in the United States for at least 3 years during his/her lifetime? *
School Name / Information
Special Services: Is your child currently enrolled in one of the following special programs? check all that apply
I hereby swear or affirm that my child was not previously suspended or expelled and is not presently suspended or expelled from any public or private school of this Commonwealth or any other state for an act or offense involving weapons, alcohol or drugs, or for the willful infliction of injury to another person or for any act of violence committed on school property. I make this statement subject to the penalties of 24 P.S. §13-1304-A(b) and 18 Pa. C.S.A. §4904, relating to unsworn falsification to authorities, and the facts contained herein are true and correct to the best of my knowledge, information and belief. *

If this student has been or is presently suspended or expelled from another school, please complete the following:

Name of School
Reason for Suspension/Expulsion
Home Language Survey

The Office of Civil Rights (OCR) requires that school districts/charter schools/full day AVTS identify limited English proficient (LEP) students in order to provide appropriate language instructional programs for them. Pennsylvania has selected the Home Language Survey as the method for this identification.

The school district/charter school/full day AVTS has the responsibility under the federal law to serve students who are limited English proficient and need English instructional services. Given this responsibility, the school district/charter school/full day AVTS has the right to ask for the information it needs to identify English Language Learners (ELLs). As part of the responsibility to locate and identify ELLs, the school district/charter school/full day AVTS may conduct screenings or ask for related information about students who are already enrolled in the school as well as from students who enroll in the school district/charter school/full day AVTS in the future.  

What is the student's first language? *
Does the student speak any language other than English? *
If Yes, please provide the following information:
Name of School
Dates Attended
Media and Internet
Students participate in classroom and school sponsored activities during the course of a school year. Certain classes and activities may be photographed, taped, videotaped, or posted to the school district website by the news media, district personnel, or other students. Likewise, live images may be relayed via cable or satellite connections to other districts or to other classrooms within our district to allow for live interactions between students and teachers at separate locations. Distance learning videotapes may be used to educate others about distance learning at seminars and other public places. Any media interaction with students must be approved in advance by the administration. Photographs, tapes, or videotapes created for commercial use are not permitted by the NASD. This involvement by students, and the sharing of educational techniques and experiences, is intended to enhance and enrich the educational opportunities of all students and staff. The school’s experiences and involvement in these areas has been positive. I/we acknowledge that the student is a minor, and certify that I/we have given consent to the Northwest Area School District permission to properly use the aforementioned media format(s). *
As the parent/guardian of this student I have read the NASD Acceptable User Policy #815. I understand that this access is designed for educational purposes and the district has taken available precautions to eliminate controversial material, however, I also recognize it is impossible for the district to restrict access to all controversial materials and I will not hold them responsible for materials these students may acquire on the district network. I herby give my permission to issue an account for the student being enrolled in this form and certify that the information contained on this form is correct. *
Parent/ Guardian Signature *