Name (last, first MI)
Home Phone  xxx-xxx-xxxx Student Number (PS#)
Home Address   Map  
Home city, state, zip ,  
Mailing Address   Map  
Mailing city, state, zip ,
Type of Residency Graduation Year
Nickname Gender  
Home Room Directory Listing Permission  
Birthdate  mm/dd/yyyy Photo/Video Permission
Ethnicity   Internet Use Permission
Family rep. District Entry Date District Entry Grade Level
CIC Student School Entry Date School Entry Grade Level
PARENT/GUARDIAN    
Lives With
Mother's Name
Mother's Day Phone   Cell Phone
Mother's Home Phone
Mother's Email
Mother's Employer
Mother's Maiden Name
Father's Name
Father's Day Phone   Cell Phone
Father's Home Phone
Father's Email
Father's Employer
Guardianship       Single Parent Household
Guardian(Last, First, Middle)
Guardian's Day Phone   Cell Phone
Guardian Email
Guardian Alert Text Alert Expires (date)
(0/0/0 to never expire)
EMERGENCY/MEDICAL INFO   
Emergency Contact #1
Contact #1 Phone
Contact #1 Relationship Phone Type  
Emergency Contact #2
Contact #2 Phone
Contact #2 Relationship Phone Type  
Emergency Contact #3
Contact #3 Phone
Contact #3 Relationship Phone Type  
Doctor Phone#
Dentist Phone#
Medical Alert Text Alert Expires (date)
(0/0/0 to never expire)
WEB ACCESS    
Guardian Access, Allow Student Access, Allow
Guardian web ID Student Web ID
Guardian web PW Student Web PW
IL STATE INFORMATION    
PreK Program
Kindergarten Program
Non-English Background
Limited English Proficient (LEP) Migrant
Low Income Family (Economically Disadvantaged) Individualized Education Plan (IEP)
Disability
ISBE SIS ID REQUEST INFO
6. Lineage (Suffix)
11. Birth Place Name (City, State or Region)

DO NOT USE COMMAS OR PERIODS 		 
18. Homeless Indicator
25. IEP Accommodation Indicator
26. 504 Accommodation Indicator
31. RCDTS Home School Number (Student Level) Enter if home school is different your school
32. RCDTS Serving School Number Only enter if different from home school
35. Full Time Equivalent (FTE) (Note: Enter a value less than or equal to one.) (#.##)  Use two decimal places
ISBE SIS ASSESMENT PRE-ID INFO
10. First Year in United States
11. Year in Any Illinois-Approved TBE/TPI Program (excluding Pre-K and K)
12. Year Since Exited TBE/TPI Program
15. Test To Be Taken

(Note: If unknown select ISAT)