Conestoga Valley School District Census Form

Please review instructions before completing
Online Instructions

If you have any questions, please email the district at census@conestogavalley.org.
Conestoga Valley School District Census Office
2110 Horseshoe Road
Lancaster, PA 17601

Note: Options for Completing:
1) No Change - Check box, Fill in Residence # and Name at bottom of form
2) Changes - Check box, Fill in Residence #, Name at bottom, and areas where changes are needed.
3) New Information - Check box, Fill in complete form.

Enter your Residence # from the top left box of the form you received in the mail - All CAPS.

Residence #

Residence/Street Address

Street:
Apt #:		City:
State:		Zip:

THIS SECTION FOR ADULTS 18 AND OVER

Name of Adult (Last, First, Middle Initial)	Delete Name (Put an X to Delete Name)	Birthdate (00/00/0000)	Gender	Head of Household (Please select only one)
1. Last Name: First Name: MI:
2. Last Name: First Name: MI:
3. Last Name: First Name: MI:
4. Last Name: First Name: MI:
5. Last Name: First Name: MI:

THIS SECTION FOR CHILDREN UNDER 18 OR STILL IN HIGH SCHOOL

Name of Child (Last, First, Middle Initial)	Delete Name (Put an X to Delete Name)	Birthdate (00/00/0000)	Gender	Name of School (For This Year)
1. Last Name: First Name: MI:
2. Last Name: First Name: MI:
3. Last Name: First Name: MI:
4. Last Name: First Name: MI:
5. Last Name: First Name: MI:
6. Last Name: First Name: MI:
7. Last Name: First Name: MI:
8. Last Name: First Name: MI:
9. Last Name: First Name: MI:
10. Last Name: First Name: MI:

PROPERTY STATUS Check one of the following Own Rent

ALL INFORMATION IS CONFIDENTIAL

I verify that the information above is complete and accurate:
Full Name:
Date:	9/25/2018
Telephone Number:
	Must check a box 1,2 or 3 at top of form before submitting.

If you have any questions, please email the district at census@conestogavalley.org

If you experience any trouble with the form, please contact us at info@dhfassociates.com