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 email from Jolene Schnackenberg, Student Information System Data Coordinator, with further instructions for completing the remainder of the online registration.
Questions? Call Jolene Schnackenberg, 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: Current Year Grade Level
**Anticipated Start Date:
Current Special Programs IEP 504 ELL Speech Therapy Gifted and Talented
**Has your child attended a Uinta #4 school previously?
**Mailing Address
**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 siblings in 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