Pre-Registration Application for Enrollment

Please complete the form below. Required fields marked with an asterisk *

Student Information

Has the student ever attended a Chicago Public School*

Answer required for "Has the student ever attended a Chicago Public School"

Yes

If yes, name of last CPS school attended:

Answer required for "If yes, name of last CPS school attended:"

CPS Student ID Number:

(if never enrolled with CPS, leave blank)

Answer required for "CPS Student ID Number:"

Last Name:*

Answer required for "Last Name:"

First Name:*

Answer required for "First Name:"

Middle Name:

Answer required for "Middle Name:"

Birthdate*

Answer required for "Birthdate"

Gender:*

Answer required for "Gender:"

Male

Female

Federal Ethnicity/Race

Federal Ethnicity Category*

Answer required for "Federal Ethnicity Category"

Hispanic

Non Hispanic

Federal Race Category:*

Check all that apply

Answer required for "Federal Race Category:"

American Indian or Alaskan Native

Asian

Black

Native Hawaiian or other Pacific Islander

White

Student Address

Address

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

Student lives with:*

Answer required for "Student lives with:"

Both Parents

Mother Only

Father Only

Guardian

Other

If "other", please explain:

Answer required for "If \"other\", please explain:"

Note: Students may not, for the sole purpose of enrolling in a particular school, live with adults who are not their parents or legal guardians.

Parent/Guardian Contact Information:

Last Name*

Answer required for "Last Name"

First Name*

Answer required for "First Name"

This Parent is: *

Answer required for "This Parent is: "

Mother

Father

Guardian

Street Address

Answer required for "Street Address"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Parent/Guardian Email*

Answer required for "Parent/Guardian Email"

Please Re-enter Email*

Answer required for "Please Re-enter Email"

Primary Phone*

Number Required

Alternate Phone

Number Required

This Parent...*

Check All That Apply

Answer required for "This Parent..."

should be contacted in emergencies

gets mailing for student

lives with student

has permission to pick student up from school

Parent/Guardian #2

Last Name

Answer required for "Last Name"

First Name

Answer required for "First Name"

Street Address

Answer required for "Street Address"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Primary Email

Answer required for "Primary Email"

Please re-enter email

Answer required for "Please re-enter email"

Primary Phone

Number Required

Alternate Phone

Number Required

This parent...

Check all that apply:

Answer required for "This parent..."

Should be contacted in emergencies only

gets mailing for student

lives with student

has permission to pick student up from school

Previous School Information

Which school are you currently attending or transferring from*

Answer required for "Which school are you currently attending or transferring from"

City

Answer required for "City"

School Type:*

Answer required for "School Type:"

Has the student EVER attended Mather High School *

Answer required for "Has the student EVER attended Mather High School "

Yes

Home Language Survey

Home Language*

Answer required for "Home Language"

Birth Country*

Answer required for "Birth Country"

Is a language other than English spoken at home?*

Answer required for "Is a language other than English spoken at home?"

Yes

Does the student speak a language other than English?*

Answer required for "Does the student speak a language other than English?"

Yes

Todays Date*

Answer required for "Todays Date"

Immigration Information

Skip to next the section if student was born in the U.S.

Date of first school enrollment in the U.S.

Answer required for "Date of first school enrollment in the U.S."

Years of education completed in the U.S.

Answer required for "Years of education completed in the U.S."

Date first entered the U.S.

Answer required for "Date first entered the U.S."

Does the student have refugee status:

Answer required for "Does the student have refugee status:"

Yes

If yes, from which nation:

Answer required for "If yes, from which nation:"

Programs:

Is the student currently receiving any type of Special Education Services? *

Answer required for "Is the student currently receiving any type of Special Education Services? "

Yes

Parent Partners

What time of day are you likely to attend a parent meeting/workshop?*

Answer required for "What time of day are you likely to attend a parent meeting/workshop?"

Morning

Afternoon

Early Evening

All of the above

Are you likely to attend a Saturday Morning Meeting?*

Answer required for "Are you likely to attend a Saturday Morning Meeting?"

Yes

What type of events are you most likely to attend (select all that apply)*

Answer required for "What type of events are you most likely to attend (select all that apply)"

College & Career Planning

Computer classes for parents

English Language Classes

Mental health/stress and anxiety

Adolescent Development

Financial planning

Healthy living

Arts and Crafts

Would you like information on how to become a volunteer at Mather?*

Answer required for "Would you like information on how to become a volunteer at Mather?"

Yes

Please be aware that after requesting enrollment online, the parent MUST come to Mather to verify identity & residency and to register the student for classes. See the Admissions page for required documentation.

Please contact Farreya Khan at 773-534-2490 with any questions.

Please fix the highlighted areas below before submitting.

Pre-Registration Application for Enrollment