Online Registration Summary

Modified By:
Modified Date:

Submission Date: 07/24/2016

Confirmation Number: # 605
Application Created By: Ranjit Umakanthan
Household

Emergency Contact
Meenakshisundaram , Jeyanthi
Birthdate: 05/23/1983

Home Phone
Home
Phone:

Home
Phone:

(313)398-7389

Verification Information

Emergency

High
Priority

Voice
Text

Attendance Behavior GeneralPrivate

X

Student
Ranjit , Hariharan
Nickname: Hari

6589 Maplewood Rd Apt. 204

Mayfield Hgts, OH 44124
Couyahoga

Gender: M

Demographics
Is Hispanic/Latino: No

Mailing Address
Parent/Guardian
Umakanthan , Ranjit
Birthdate: 01/23/1979

Gender: M
Household: Yes

Is non-custodial parent: No
Has shared parenting: No

Contact Information

Homeless: No

Jeyanthi1983@gmail.com
High
Priority

Race Ethicity
Asian
School Choice : Center School
Student Cell Number:
Student Email:
Date Entered U.S.: 07/03/2016
Foreign Exchange: Yes
Enrollment Grade: 03

Housing

Ranjit.u@gmail.com

Emergency

Voice
Text
Work: Voice
Text
Email:
Secondary
Email:

Address Line 1: Same as student

Address Line 2: Same as student

Home Address

Cell:
Work:
Email:
Secondary
Email:

Gender: F
Household: Yes

Student Services

Attendance Behavior GeneralTeacher Private

Cell:

Student has IEP: No

Student has 504 plan: No
Student received gifted/talented services: No

Language Information
X
X

Emergency Contact
Umakanthan , Ranjit
Birthdate: 01/23/1979

Gender: M
Household: Yes

Student language: Tamil

Parent/Guardian language: Tamil
First language spoken by student: English
Language most often spoken at home: English
Language most often spoken with friends: English
Student has received ELL services: No

Contact Information

Previous Schools

Home:
Mobile: (313)398-7389
Work:
Email: Jeyanthi1983@gmail.com

Last Year
School: Narayana Group Of School
City: Chennai
State:
Country: India
Phone:
Currently expelled or suspended: No

Verification Information
Address Line 1: Same as student
Address Line 2: Same as student

Emergency Contact
Meenakshisundaram , Jeyanthi
Birthdate: 05/23/1983

Contact Information
Home:
Mobile: (313)398-7389
Work:
Email:

Gender: F
Household: Yes

DOB:
02/06/2009

Student
Ranjit , Hariharan
Nickname: Hari

Gender: M

DOB:
02/06/2009

Relationships
Ranjit Umakanthan - Father
Guardian: true
Mailing: true
Portal: true
Messenger: true
Secondary Household false
Contact Order: 1
Ranjit Umakanthan - Father
Contact Order: 2
Jeyanthi Meenakshisundaram - Mother
Contact Order: 3

Health Services - Emergency Information

Primary Care Provider:
Primary Care Phone:
Dentist name:
Dentist Phone:
Preferred Hospital:
Agrees to hospital consent agreement: Yes

Health Services - Medical or Mental Health

Conditions
No medical or mental health conditions

Health Services - Medications / Immunizations

No medications

Release Agreements
Consent given to the School and/or District's use of my child's
photograph, voice and/or name in various media projects - Yes
Agrees to Code of Conduct: Yes
Agrees to Technology Terms: Yes
Agrees to Student Email Terms: Does Not Apply (K-2)
Consent given for my child to participate in School and/ or District
approved field trips - Yes

Excel/Cevec
Excel Tech Accepted: No

Signature: