Student Enrollment Form

State

School / District

Student Information

First Name

Middle Name

Last Name

Gender

Date of Birth

Place of Birth

Race

Verify Email

Phone

Social Security #

Driver's Licence

Address

City

State

Zip

Academic Information

Last Grade Completed

Last School

Do you have an IEP (Individualized Education Plan)?

County / Parish Name

Student ID#

Location / City

Parent or Guardian Information

First Name

Last Name

Suffix

Phone

Address same as student

Address

City

State

Zip

Parent or Guardian Information 2 / Additional Contact

First Name

Last Name

Suffix

Phone

Address same as student

Address

City

State

Zip

DPS&C Reporter Information

Name

Phone

Parole/Probation Officer Information

Name

Phone

Interests

What are you interested in after you graduate?

Select this checkbox and fill the mailing address if you need a device.

Are you wanting to join the workforce or go to college?

Street Address

City

State

Zip

Required Documents

Documents can be attached on the site and uploaded or emailed to enrollment@graderesults.com or faxed to 866.937.8871, or mailed to Grade Results at 1316 Newport Dr., Carrollton, TX 75006.

Birth Certificate

Social Security Card

Proof of Residence

Proof of Immunization and Health Screenings

Prior Academic Records

IEP/504 Documentation

Transcript Documentation

Other Documents for Special Circumstances

Custody order, Gifted documentation, Special Education Documentation: IEP Documentation: Supporting Evaluation Documentation, IEP Exit Documentation, 504 Plan

Select Document

To be filled by Parent/Guardian

What are your plans post-secondary?

Student Signature

Clear

Parent Signature

Clear

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Student Enrollment Form

Student Information

Academic Information

Parent or Guardian Information

Parent or Guardian Information 2 / Additional Contact Add Parent

DPS&C Reporter Information

Parole/Probation Officer Information

Interests

Required Documents

To be filled by Parent/Guardian

Student Signature

Parent Signature

Parent or Guardian Information 2 / Additional Contact