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 ID# from the top left box of the form you received in the mail. Note - Do NOT enter your mailing address here!

(All CAPS)
(Include DASH as shown)
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:12/15/2018
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

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