Census Form

If you have any changes to your household or are new to the district please fill in the form and click Submit.

* Any field marked with a * is required.

Residents	First Name: Last Name:
	* Home Phone: Work Phone: Cell Phone: Email Address:
	First Name: Last Name:
	Home Phone: Work Phone: Cell Phone: Email Address:

*Street Address
*City State Zip
Mailing Address (If Different)
City State Zip

Check here if there are no children in the household.
Comments:

* New York State Education Department is now allowing parents to choose Hispanic/Latino ethnicity and multiple racial groups for their children. Using the race codes below, please verify your child's race. For example, verify Hispanic / Latino ethnicity with Y or N and verify your child's race(s) by typing the appropriate race code(s) in the Race column. New York State requires all students to have an ethnicity and at least one race code selected.

Racial Groups

A - Asian

B - Black or African-American

I - American Indian or Alaskan Native

P - Native Hawaiian / Other Pacific Islander

W - White

The information below is only required if you have children in your household. Please complete all columns for each child.

Student First Name	Student Last Name	Birthdate	Gender	Hispanic/Latino Y/N	Race (See Chart Above)	Name of School Attending (public or private)	Current Grade