Elizabethtown Area School District Census Form

Please review instructions before completing
Online Instructions

If you have any questions, please call the district at 717-367-1521 ext. 1000, or email us at census@etownschools.org.
Elizabethtown Area School District Census Office
600 E. High Street
Elizabethtown, PA 17022

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

Enter your Dwelling# from the top left of the form you received in the mail.

Dwelling #



Residence/Street Address
Street:
Apt #: City:
State: Zip:




THIS SECTION FOR ADULTS 18 AND OVER
Name of Adult
(Last, First, Middle Initial)
Individual ID#
(6 digit # to right
of name on form)
Delete Name
(Put an X to
Delete Name)
Sex Birthdate
(00/00/0000)
Marital
Status
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)
Individual ID#
(6 digit # to right
of name on form)
Delete Name
(Put an X to
Delete Name)
Sex Birthdate
(00/00/0000)
School Code Name of School
(For Next Year)
Grade
(Next 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:

If you expect to move prior to July 1, please note date and new address: Date:
Street:
Apt:
City/State/Zip:

ALL INFORMATION IS CONFIDENTIAL

I verify that the information above is complete and accurate:
Full Name:
Date:12/15/2018
Telephone Number:   Check if Unlisted
  Must check a box 1,2 or 3 at top of form before submitting.


If you have any questions, please call the district at 717-367-1521 ext. 1000, or email us at census@etownschools.org

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

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