Student Information
Child's Full Legal Name

Hebrew Name (if any)

Date of Birth

Social Security Number

Grade in 2024–2025 School Year

Does your child have an IEP (Individualized Education Plan)?

If yes, please upload a copy of your child's IEP.

If entering kindergarten, has your child attended any preschool(s)?

If yes, name of school:

If entering first through eighth grade, provide list of schools your child has attended. Please include the district, city, and state for each.

Parent/Legal Guardian #1 Information
First Name

Last Name

Relationship to the Child

Mailing Address

City

State

Zip Code

Home Phone

Cell Phone

Preferred Email Address for School Communication

Occupation/Employer

Work Phone

Parent/Legal Guardian #2 Information
First Name

Last Name

Relationship to Child

Mailing Address

City

State

Zip Code

Home Phone

Cell Phone

Preferred Email Address for School Communication

Occupation/Employer

Work Phone

Family Information
Public School District

Religious Affiliation

Is your family a member of an Omaha synagogue?

If yes, which one?

Child's Siblings (Names and Ages)