Great Valley School District Census Form

Please review instructions before completing
Online Instructions

If you have any questions on the census, please call the
district office at 610-889-2125 ext. 2152.
Great Valley School District
47 Church Road
Malvern, PA 19355

Important: Enter the 6 digit dwelling # from
the census form you received for this address:

Dwelling #

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

THIS SECTION FOR ADULTS 18 AND OVER
 * optional information
Name of Adult
(Last, First, Middle Initial)
Birthdate
(00/00/0000)
*Sex
 
*Marital
Status
*Race
 
*Educational
Attainment
*Employment
Status
*Employer
Zip Code
1. Last Name:
First Name: MI:
2. Last Name:
First Name: MI:
3. Last Name:
First Name: MI:
4. Last Name:
First Name: MI:

THIS SECTION FOR CHILDREN UNDER 18 OR STILL IN HIGH SCHOOL
 * optional information
Name of Child
(Last, First, Middle Initial)
Birthdate
(00/00/0000)
*Sex
 
*Parent/
Guardian
*Race
 
Grade
 
School
Code
Name of School
 
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:

CHILD DISABILITIES
Have any of the children above been diagnosed with disabilities?
Yes     No
INTERNET
What is your internet connection speed?
Moderate (i.e., 56k Dialup)
High (i.e., DSL/Cable)
Don't Know

PROPERTY STATUS
Check one of the following Own   Rent

IF OWN:
Owner Occupied
Tenant Occupied
Vacant

Residence Type
IF RENT:
Landlord's Name:
Landlord's Phone#:
Street/Apt #:
City/State/Zip:

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:9/25/2018
Telephone Number:   Check if Unlisted
 


If you have any questions on the census, please call the district office at 610-889-2125 ext. 2152.
Great Valley School District
47 Church Road
Malvern, PA 19355

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

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