Name: First Middle Last
Birth Date: Month Day Year
Home Address: Street City Zip Code
Phone Number: Secondary Phone Number: e.g 123-456-7890
Email Address of Parent/Guardian:
Does the student have a sibling currently attending Madison District Schools under the schools of choice program? yes no Name of sibling:
Current grade of student Pre-K K 1 2 3 4 5 6 7 8 9 10 11 12
School District of Home Address: Name of Current School:
Which school are you applying to?
Madison Early Childhood Center (MECC)
Madison Elementary School (MES)
Wilkinson Middle School (WMS)
Madison High School (MHS)
Madison Preparatory High School (Prep)
How did you hear about Madison District Public Schools? Direct MailFacebookRadioTVFrom a friendOther
Has the student been suspended from school within the last two school years? yes no
Has the student ever been expelled from school? yes no
Does this student have any special needs? yes no Does the student have an I.E.P.? yes no
What is your child's Native Language?
Is the primary language in your child’s home a language other than English? yes no
If yes, what is the language?
Immigration date, if not born in the U.S.
I understand that by typing my name I am signing this application. I certify all of the information provided above to be true and correct. I acknowledge and accept the policies and stipulations of the Madison District Schools. I understand false or incomplete information will result in the removal of the applicant from Madison Schools programs.
Full name of parent or guardian: Date:
Contact Web Administrator
South High School does not discriminate on the basis of race, color, national origin, sex, age, or disability in admission to its programs, services, or activities, in access to them, in treatment of individuals, or in any aspect of their operations. The lack of English language skills shall not be a barrier to admission or participation in the district’s activities and programs. South High Public Schools also does not discriminate in its hiring or employment practices.