E-STEM Application
2019/2020

Ed H. White Elementary is accepting Kindergarten Students
Walter Hall Elementary is accepting Kindergarten and First Grade Students
Applications Due By: 5/17/2019 3:30:00 PM
Student Information
*Student Last Name:
*Student First Name:
Student Middle Name:
*Student Date Of Birth (MM/DD/YYYY):
*E-STEM Program applying for?
*E-STEM program Grade applying for :
*What language does your child speak most of the time?
*What language is spoken in the home most of the time?
*Does your child lives within CCISD school district?
*Did the student attend pre-k/pre-school?
*Student Gender:
*Student's attending zone school:
Other Children Living at Home
   Child's Name Child's Age Child's School
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Parent/Guardian Information and Additional Comments
*Last Name:
*First Name:
Middle Name:
*Email:
*Mailing Address:
*City:
*State:
*ZIP Code:
*Home Phone (Primary):
Work Phone:
Cell or Other Phone:

Additional Comments / Information:
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