Census Information - Seymour Community School District

Census Information

Census form:

Seymour Community School District Census

Each year the Seymour Community School District is required by state statute to report to the Wisconsin Department of Public Instruction the number of children, by age and gender, who reside within the district boundaries. This census counts all children from ages new born through 20. So if you are new to the district or have moved within the district it is important that we keep our count as accurate as possible. This information is also important when sending out letters to parents regarding any pre-school or Kindergarten screenings.

Thank you for your cooperation in completing the form below.

Parent/Guardian Last Name

First Name

Middle Initial

Relationship to Child (i.e. Father, Step-mother etc.)

Spouse or Second Adult Last Name

First Name

Middle Initial

Relationship to Child (i.e. Father, Step-mother, etc.)

Physical Home Address

P. O. Box Number

City/Village

State

Zip Code

Home Telephone Number

Cell Phone Number

Email Address

County

	Outagamie
	Shawano

Township, City or Village of

Child's Data

1. List any child between the ages of new born to 20 years of age residing at the address listed above.

2. If any child has a diagnosed disability, and needs special education services from the school district, mark the Special Needs box.

Last Name

First Name

M.I.

Gender

	Male
		Female

Birthday (MM/DD/YYYY)

Ethnic code

School attending Fall of 2010

Grade Attending, Fall 2010

	Pre-K
		6
	Kdgn
		7
	1
		8
	2
		9
	3
		10
	4
		11
	5
		12
	Not enrolled

Special Needs: If your child has a diagnosed disability, and needs special education services from the school district, choose the "Yes" button.

	Yes
		No

Type in the text that you see above: