Form DoDEA Form 600 DoDEA Form 600 Student Registration

DEPARTMENT OF DEFENSE EDUCATION ACTIVITY
STUDENT REGISTRATION
SY
/

Please read the Privacy Act Statement and Agency Disclosure Notice on the back before completing the form.

OMB No.: 0704-0495
OMB Approval Expires:
XX-XX-XXXX

INSTRUCTIONS: RETURN COMPLETED FORM TO THE SCHOOL WHERE THE STUDENT IS ENROLLING.
This form is completed by the sponsor, who is a parent or legal guardian, to request enrollment of his/her dependent(s) at a DoDEA school. A dependent is a
minor individual who has not completed secondary schooling and who is the child, stepchild, adopted child, ward or spouse of the sponsor. The information
collected is used internally to determine the student's eligibility to enroll on a tuition-free or tuition-paying basis, and whether the student is space-required or
space-available. It is also used to ensure that DoDEA makes available the appropriate classrooms, staffing, and supportive educational services, places
students in the appropriate grade, identifies students with special needs, and to ensure compliance with laws protecting student rights. Detailed instructions may
be found on page 3 of this form.
SECTION I - SPONSOR INFORMATION
1. TITLE (Mr./Mrs./Rank) 2. SPONSOR NAME (Last, First, Middle Initial)

3. RELATIONSHIP TO STUDENT

4. TELEPHONE NUMBERS (Include Area Code or DSN)
Duty/Work

Home

Cell

6. ROTATION/DEPARTURE DATE
(DEROS/PRD) (yyyymmdd)

5. BRANCH OF SERVICE/PAY GRADE
(Ex. E1/01/GS-1)

8. MILITARY INSTALLATION (City/Country of Assignment)

7. ORGANIZATION/UNIT

9. EMAIL ADDRESS

11. PHYSICAL QUARTERS
(Street, City, State, &Zipcode) (Enter only if different from mailing address)

10. MAILING ADDRESS
(e.g., Local/APO/FPO)(Required)

SECTION II - SPONSOR'S SPOUSE INFORMATION
3. RELATIONSHIP TO STUDENT

1. TITLE (Mr./Mrs./Rank) 2. SPOUSE NAME (Last, First, Middle Initial)

4. TELEPHONE NUMBERS (Include Area Code or DSN)
Duty/Work

Home
5. EMAIL ADDRESS

Cell
6. DUAL MILITARY. Are both the sponsor and spouse active duty military?
Yes

No

SECTION III - PREFERRED EMAIL ADDRESS (School Correspondence)
2. SECONDARY EMAIL ADDRESS

1. PRIMARY EMAIL ADDRESS

SECTION IV -EMERGENCY CONTACT & RELEASE INFORMATION
The person(s) identified in sections 1a - 3e should be an adult who can take responsibility for the parent(s). This person(s) will be contacted if there is an
emergency and the sponsor/spouse cannot be contacted. I permit the dependents that I am registering with this form to be released to the emergency contact(s)
identified in this section if I or my spouse are not available.
1c. RELATIONSHIP TO STUDENT
1a. TITLE (Mr./Mrs./Rank) 1b. PRIMARY LOCAL EMERGENCY CONTACT NAME (Last, First, Middle Initial)

1d. TELEPHONE NUMBERS (Include Area Code or DSN)
Duty/Work

Home
2a. TITLE (Mr./Mrs./Rank)

Cell

2b. SECONDARY LOCAL EMERGENCY CONTACT NAME (Last, First, Middle Initial)

2c. RELATIONSHIP TO STUDENT

2d. TELEPHONE NUMBERS (Include Area Code or DSN)
Duty/Work

Home
3a. TITLE (Mr./Mrs./Rank)

Cell

3b. PERMANENT STATESIDE EMERGENCY CONTACT NAME (Last, First, Middle Initial)

3c. RELATIONSHIP TO STUDENT

3d. TELEPHONE NUMBERS (Include Area Code or DSN)
Home

Duty/Work

Cell

3e. PERMANENT STATESIDE ADDRESS

DODEA FORM 600, DEC 2019

REPLACES SD FORM 600, WHICH IS OBSOLETE.

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DEPARTMENT OF DEFENSE EDUCATION ACTIVITY
STUDENT REGISTRATION
SECTION V - STUDENT INFORMATION
1. STUDENT LEGAL NAME As it appears of the Birth Certificate including Jr., III, etc. (Last, First, Middle)

4. SEX
(Select One)
F

5. DATE OF BIRTH
(yyyymmdd)

2. PREFERRED NAME

7. PASSPORT NUMBER

6. STUDENT CELL PHONE
(Include Area Code)

3. GRADE

8. PASSPORT EXPIRATION
DATE (yyyymmdd)

M

9. ETHNICITY & RACE
The Federal Government requires that both of the following questions be answered and provides only the
following categories for ethnic group and race. See the instructions (page 3) for more clarification.
9a. Is the student Hispanic or Latino? (Choose only one)

10. OTHER CHILDREN IN FAMILY
Date of Birth
(yyyymmdd)

Name(s)

9b. What is the student's race?

Hispanic or Latino

American Indian or Alaska Native

Not Hispanic or Latino

Asian
Black or African American
Native Hawaiian or Other Pacific Islander

11. PRIMARY LANGUAGE USED AT HOME
(Regardless of the language spoken by the student)

White
12. WHAT LANGUAGE IS MOST OFTEN SPOKEN
BY THE STUDENT?

13. WHAT IS THE LANGUAGE THAT THE
STUDENT FIRST ACQUIRED?

SECTION VI - HEALTH INFORMATION
The requested information is for use in an emergency and to ensure compliance with immunization requirements.
1. PHYSICIAN OR MEDICAL FACILITY NAME

2. PHYSICIAN OR MEDICAL FACILITY TELEPHONE NUMBER
(Include area code or DSN)

3. STUDENT HEALTH HISTORY (Check & Initial)

4. IMMUNIZATIONS (Only for new students) (Check & Initial)

I have provided school officials with the DoDEA Form 1 SHSM H-1-1 "Student
Health History"

Yes, I have provided a copy of the Immunization
Record

5. DOES THE STUDENT HAVE A HEALTH CONDITION REQUIRING POSSIBLE
EMERGENCY CARE? (Check One)
Yes

No

I will provide a copy of the Immunization record as
soon as possible. There is a provision allowing a 30calendar day grace period to meet immunization
requirements for school registration.

If yes, specify

SECTION VII - SPONSOR/LEGAL GUARDIAN VERIFICATION
I declare under the penalty of perjury that the statements made by me on this form are true, complete and correct. I understand that I must immediately report
any changes that may affect my dependent student's eligibility. (Specifically Sponsor's employment status)
Printed Name

Text
STUDENT NAME

SCHOOL NAME

Signature

Date (yyyymmdd)

SECTION VIII - SCHOOL USE ONLY
STUDENT
ENROLLMENT/EMPLOYER CODE
GRADE
(Category Code)

ORDERS ON FILE/
VERIFIED
Yes

No

FIRST DAY STUDENT STARTS
SCHOOL (yyyymmdd)

BIRTH DATE VERIFIED: Birth Certificate or Passport for
PK, SS, KN and First Grade (Retain on File)
Yes

No

I VERIFY THAT THE INFORMATION IS CORRECT:
REGISTRAR
NAME

REGISTRAR
DATE
SIGNATURE:
(yyyymmdd)
AGENCY DISCLOSURE NOTICE (ADN)
The public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, by emailing:
[email protected]. [OMB Control Number: 0704-0495] Respondents should be aware that notwithstanding any other
provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control
number.
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. Section 2164, and 20 U.S.C. Sections 921-932.
PRINCIPAL PURPOSE(S): To obtain information necessary to enroll students, administer school operations, and protect student health and welfare in DoD
operated dependent educational programs. Completed forms are covered by the DoDEA Dependent Children's School Program Files SORN located at located
at http://privacy.defense.gov/notices/DODEA26.shtml.
ROUTINE USE(S): To Federal, State and local government officials to protect health and safety in the event of emergencies. The DoD Blanket Routine Uses
found at http://privacy.defense.gov/blanket_uses.shtml also apply to this collection.
DISCLOSURE: Voluntary; however, failure to disclose the information collected on this form may delay and/or prevent the enrollment of a child and/or the
delivery of educational and emergency services.

DODEA FORM 600 (BACK), DEC 2019

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DEPARTMENT OF DEFENSE EDUCATION ACTIVITY
STUDENT REGISTRATION
INSTRUCTIONS FOR COMPLETING DODEA FORM 600
SECTION I - SPONSOR INFORMATION
1. TITLE. Enter the sponsor's title as Mr., Mrs., Ms., Military Rank (SFC, LT,
CDR, Etc.).
2. SPONSOR NAME. Enter the sponsor's name following the format provided.
3. RELATIONSHIP TO STUDENT. Enter the sponsor's relationship to the
student (father, mother, stepfather, etc.).
4. TELEPHONE NUMBERS. Enter sponsor's telephone number including area
code for the following: Home, Duty/Work, and Cell.
5. PAY GRADE. Enter the sponsor's pay grade (E1, O1, GS-1, etc.).
6. ROTATION/DEPARTURE DATE. Enter the sponsor's DEROS (Date
Estimated Return Overseas) or PRD (Projected Rotation Date).
7. ORGANIZATION/UNIT. Enter the sponsor's unit or organization.
8. MILITARY INSTALLATION. Enter the military installation/base where the
sponsor's unit or organization is located.
9. EMAIL ADDRESS. Enter the sponsor's email address, either work or
personal email.
10. MAILING ADDRESS. Enter the sponsor's local mailing address including
APO/FPO. Required.
11. PHYSICAL QUARTERS. Enter only if different from the mailing address.
Street, City, State.
SECTION II - SPONSOR'S SPOUSE INFORMATION
1. TITLE. Enter the spouse's title as Mr., Mrs., Ms., Military Rank (SFC, LT,
CDR, Etc.).
2. SPOUSE'S NAME. Enter the spouse's name following the format provided.
3. RELATIONSHIP TO STUDENT. Enter the spouse's relationship to the
student (father, mother, stepfather, etc.).
4. TELEPHONE NUMBERS. Enter spouse's telephone number including area
code for the following: Home, Duty/Work, and Cell.
5. EMAIL ADDRESS. Enter the spouse's email address, either work or
personal email.
6. DUAL MILITARY. Are both the sponsor and spouse active duty military?
Check yes or no.
SECTION III - PREFERRED EMAIL ADDRESS (School Correspondence)
1. PRIMARY EMAIL ADDRESS. Enter the primary email address to be used
for school correspondence.
2. SECONDARY EMAIL ADDRESS. Enter the secondary email address to be
used for school correspondence.
SECTION IV - EMERGENCY CONTACT & RELEASE INFORMATION
In the event of an emergency, school staff members will attempt to contact the
enrolling parent/spouse/guardian first. It is very important that at least (2) local
responsible adults (other than family members or friends) be listed in this section
in case the enrolling parent/spouse/guardian cannot be contacted.
1. PRIMARY LOCAL EMERGENCY CONTACT.
a. TITLE. Enter the title as Mr., Mrs., Ms., Military Rank (SFC, LT, CDR, Etc.).
b. NAME. Enter the name following the format provided.
c. RELATIONSHIP TO STUDENT. Enter the relationship to the student (father,
mother, stepfather, etc.).
d. TELEPHONE NUMBERS. Enter the telephone number including area code
for the following: Home, Duty/Work, and Cell.
2. SECONDARY LOCAL EMERGENCY CONTACT
a. TITLE. Enter the title as Mr., Mrs., Ms., Military Rank (SFC, LT, CDR, Etc.).
b. NAME. Enter the name following the format provided.
c. RELATIONSHIP TO STUDENT. Enter the relationship to the student
(father, mother, stepfather, etc.).
d. TELEPHONE NUMBERS. Enter the telephone number including area code
for the following: Home, Duty/Work, and Cell.
3. PERMANENT STATESIDE EMERGENCY CONTACT
a. TITLE. Enter the title as Mr., Mrs., Ms., Military Rank (SFC, LT, CDR, Etc.).
b. NAME. Enter the name following the format provided.
c. RELATIONSHIP RELATIONSHIP TO STUDENT. Enter the relationship to
the student (father, mother, stepfather, etc.).
d. TELEPHONE.TELEPHONE NUMBERS. Enter spouse's telephone number
including area code for the following: Home, Duty/Work, and Cell.
e. PERMANENT STATESIDE ADDRESS

DODEA FORM 600 (INST), DEC 2019

SECTION V - STUDENT INFORMATION
1. STUDENT LEGAL NAME. Enter the student's name as it appears on the
birth certificate or other legal documentation (including suffixes, Jr., Sr., III, etc.)
using the format provided. This name will appear in the Student Information
System (SIS).
2. PREFERRED NAME. Enter student's preferred name.
3. GRADE. Enter the student's grade.
4. SEX. Enter the student's sex.
5. DATE OF BIRTH. Enter the student's date of birth from the Birth Certificate
or other legal documentation using the format provided.
6. STUDENT CELL PHONE. Enter student's cell phone.
7. PASSPORT NUMBER. Enter the student's passport number.
8. PASSPORT EXPIRATION DATE. Enter the student's passport expiration
date. It is a requirement for all students at W.T. Sampson ES/HS, Guantanamo
Bay, Cuba and for high school students traveling for sports competitions.
9. ETHNICITY & RACE. Required by the Federal Government. The collection
of this data is used for federal statistical purposes, program administrative
reporting, and/or civil rights compliance reporting.
a.
Is the student Hispanic or Latino? Check one.
i.
Yes, if a person of Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture or origin, regardless of race).
ii.
No, if not Hispanic or Latino by the definition above.
b.
What is the student's race? Check all that applies.
i.
American Indian or Alaska Native. A person having origins in any of
the original peoples of North and South America (including Central America),
and who maintains tribal affiliation or community attachment.
ii.
Asian. A person having origins in any of the original peoples of the
Far East, Southeast Asia, or the Indian subcontinent including, for example,
Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine
Islands, Thailand, and Vietnam.
iii.
Black or African American. A person having origins in any of the
Black racial groups of Africa.
iv.
Native Hawaiian or other Pacific Islander. A person having origins in
any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
v.
White. A person having origins in any of the original peoples of
Europe, the Middle East, or North Africa.
SECTION VI - HEALTH INFORMATION
1. PHYSICIAN OR FACILITY NAME.
2. PHYSICIAN OR MEDICAL FACILITY NUMBER.
3. STUDENT HEALTH HISTORY.
4. IMMUNIZATIONS.
5. DOES THE STUDENT HAVE A HEALTH CONDITION REQUIRING
POSSIBLE EMERGENCY CARE? Check yes or no. If yes, specify in the
space provided.
SECTION VII - SPONSOR/LEGAL GUARDIAN VERIFICATION
Must be signed and dated (or digitally signed) by the sponsor/spouse/legal
guardian. Report to the school registrar immediately if there is a change on the
sponsor's employment status.
SECTION VIII - SCHOOL USE ONLY
The school registrar/enrollment clerk must complete this section.

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