District 191 Student Census

Discover the opportunities within District 191! Plan for the future to ensure resources are available for your children before they start attending school. By completing this census form, you can stay connected to District 191 and receive information about programs and classes that may be of interest to your family.

Your data will be kept private. If you prefer, you can complete the census by calling the District 191 Enrollment Center at 952-707-4180.

Thank You!

Sincerely,
District 191 Enrollment Center Staff

Para hablar con alguien en español, por favor llame al 952-707-4180.
Haddii aad u baahan tahay inaad lahadasho qof Soomaali ah, fadlan soo wac 952-707-4180.

1. Please list each child in your home ages 0-21, including their name, gender and birthdate. If you need more space, please use the "Additional Children" text box below.

Space Cell	Name	Gender	Birthdate (MM/DD/YYYY)
Child 1	Child 1: Name	Child 1: Gender	Child 1: Birthdate (MM/DD/YYYY)
Child 2	Child 2: Name	Child 2: Gender	Child 2: Birthdate (MM/DD/YYYY)
Child 3	Child 3: Name	Child 3: Gender	Child 3: Birthdate (MM/DD/YYYY)
Child 4	Child 4: Name	Child 4: Gender	Child 4: Birthdate (MM/DD/YYYY)

2. Additional Children - If you need more space, please list additional children in the text box below. Include name, gender and birthdate (e.g. John Smith, M, 01/01/2001)

3. Parent/Guardian Information

Space Cell	Name	Gender	Relationship to Child
Parent/Guardian 1	Parent/Guardian 1: Name	Parent/Guardian 1: Gender	Parent/Guardian 1: Relationship to Child
Parent/Guardian 2	Parent/Guardian 2: Name	Parent/Guardian 2: Gender	Parent/Guardian 2: Relationship to Child

4. Contact Information

Street Address

City

State

Zip

Primary Phone

Email Address

District 191 Student Census

Stay connected with District 191!