Military Member in Household Form

Please complete the form below if a military parent, stepparent or legal guardian resides in your household.

Children of the Military are determined by the following criteria:

A military parent is defined as a person serving full time in the United States Military (Army, Navy, Air Force, Marines, or Coast Guard),
or is a deployed member of the National Guard or Reserves of one of the five listed branches.
If the military parent is the biological parent, step-parent or legal guardian, with full or partial physical custody of the child, and resides with the child when not deployed, then the child is considered the child of the military.
Children of parents who serve in a foreign military service, even if the student is an American citizen are not considered children of the military.

Please note this information will only be housed in the child’s student information system as requested by the Pennsylvania Department of Education.

Parent/Guardian Name

First Name Last Name

Parent/Guardian Email

Confirmation EmailType your email address here again for conformation

Student Name, 1st Child

First Name Last Name

1st Child Current Grade

Student Name, 2nd Child

First Name Last Name

2nd Child Current Grade

Student Name, 3rd Child

First Name Last Name

3rd Child Current Grade

Student Name, 4th Child

First Name Last Name

4th Child Current Grade

Student Name, 5th Child

First Name Last Name

5th Child Current Grade

Student Name, 6th Child

First Name Last Name

6th Child Current Grade