Register for On-line Access
iPass
Improving K-12 Education Through Software
2008-2009
Personal Information
Title:
Mr.
Mrs.
Dr.
Ms
.
Miss
Gender:
Female
Male
*
First Name:
Middle Name:
*
Last Name:
*
Email:
*
Workplace:
*
indicates a required field.
Primary Student Information
*
Student ID:
*
First Name:
Middle Name:
*
Last Name:
*
DOB:
e.g. mm/dd/yyyy
*
City of birth:
Student lives with me.
Relationship to Student:
Please select relationship
Aunt
Aunt-Guardian
Daughter
Emergency Contact
Father
Foster Mother
Foster-Father
Grandfather
Grandmother
Guardian
Mother
Mother/step-dad
Neighbor
Other
Parents
Sister
Son
Spouse
Stepfather
Stepmother
Uncle
Address Information
Type:
Home
Mailing
Other
Student
Summer
Work
Street No:
Street Name:
Apt
Address 2:
City:
State:
.
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illnois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Zip Code
Telephone Numbers
*
Phone:
Ext:
Type:
.
Beeper
Cell Phone
Emergency Contact
Home Phone
Pager
Student's Phone
Work Phone
Rank:
1
2
3
4
e.g. 999-999-9999
Phone:
Ext:
Type:
.
Beeper
Cell Phone
Emergency Contact
Home Phone
Pager
Student's Phone
Work Phone
Rank:
1
2
3
4
Phone:
Ext:
Type:
.
Beeper
Cell Phone
Emergency Contact
Home Phone
Pager
Student's Phone
Work Phone
Rank:
1
2
3
4
Phone:
Ext:
Type:
.
Beeper
Cell Phone
Emergency Contact
Home Phone
Pager
Student's Phone
Work Phone
Rank:
1
2
3
4
Internet User Information
*
User ID:
The Password must be at least 6 characters long.
The Password cannot contain your User ID.
*
Password:
*
Verify Password:
Additional Student 2
Student ID:
First Name:
Middle Name:
Last Name:
DOB:
e.g. mm/dd/yyyy
City of birth:
Student lives with me.
Relationship to Student:
Please select relationship
Aunt
Aunt-Guardian
Daughter
Emergency Contact
Father
Foster Mother
Foster-Father
Grandfather
Grandmother
Guardian
Mother
Mother/step-dad
Neighbor
Other
Parents
Sister
Son
Spouse
Stepfather
Stepmother
Uncle
Additional Student 3
Student ID:
First Name:
Middle Name:
Last Name:
DOB:
e.g. mm/dd/yyyy
City of birth:
Student lives with me.
Relationship to Student:
Please select relationship
Aunt
Aunt-Guardian
Daughter
Emergency Contact
Father
Foster Mother
Foster-Father
Grandfather
Grandmother
Guardian
Mother
Mother/step-dad
Neighbor
Other
Parents
Sister
Son
Spouse
Stepfather
Stepmother
Uncle
Additional Student 4
Student ID:
First Name:
Middle Name:
Last Name:
DOB:
e.g. mm/dd/yyyy
City of birth:
Student lives with me.
Relationship to Student:
Please select relationship
Aunt
Aunt-Guardian
Daughter
Emergency Contact
Father
Foster Mother
Foster-Father
Grandfather
Grandmother
Guardian
Mother
Mother/step-dad
Neighbor
Other
Parents
Sister
Son
Spouse
Stepfather
Stepmother
Uncle
Additional Student 5
Student ID:
First Name:
Middle Name:
Last Name:
DOB:
e.g. mm/dd/yyyy
City of birth:
Student lives with me.
Relationship to Student:
Please select relationship
Aunt
Aunt-Guardian
Daughter
Emergency Contact
Father
Foster Mother
Foster-Father
Grandfather
Grandmother
Guardian
Mother
Mother/step-dad
Neighbor
Other
Parents
Sister
Son
Spouse
Stepfather
Stepmother
Uncle
