THIS FORM IS FOR NEW STUDENT ENROLLMENT ONLY.

The first step in enrolling your student in Uinta County School District No. Four (Mountain View) is to provide us with the following information. You will receive an automated reply from powerschool@uinta4.com at the e-mail address you provide below. Questions? Call Sherri Stucki, Student Information System Data Coordinator, at 307-782-3377 extension 7218.



Student Information
Legal Name from Birth Certificate
**Legal Name: **First: Middle: **Last:
**Date of Birth: MM/DD/YYYY
**Gender:
Preferred First Name:
**School:
**Previous School:
Enter NONE in all three boxes
if Kindergarten student
School Name:
City:
State:
**Grade Level: 2019-2020 Grade Level
**Anticipated Start Date:
Current Special Programs IEP 504 ELL Speech Therapy
**Has your child attended a Uinta #4 school previously?
**Mailing Street
**Mailing City
**Mailing_state
**Mailing_zip
**Is the student Hispanic/Latino?
**Ethnicity
Parent/Guardian Information
**First Name: **Last Name:
**Relationship to Student:
Other Students in Family: Check this box if other members of your family are active students at our schools
**Desired User Name: Desired User Name for PowerSchool Login
**Email:
**Phone: 999-999-9999      Alternate Phone: 999-999-9999
**Street:
**City:
**State:
**Zip Code:
**Verification: I verify that the above information is correct
** Required Information