Thank you for taking the time to complete this Student Data Form. This information is necessary for us to provide all of our students with a safe and productive learning environment. All students registered at JRTI must have this information on file.

Instructions

  1. Make sure you are using a modern browser such as Chrome, FireFox, Safari, or Edge. Older browsers are not supported.
  2. Please fill out this online form as completely as possible. All fields marked with a red asterisk (*) are required.
  3. After you submit this form, check your email for a response.
  4. Download the two-page signature form regarding school policies. This form is required to complete registration.
    1. Refer to the Resources section of this website for policy information.
    2. Print the signature form, and return it to JRTI with all of the required signatures.
    3. The signature form can be submitted in person or mailed to:

James Rumsey Technical Institute
3274 Hedgesville Rd
Martinsburg, WV 25403

Student Information

This is the student's WVEIS number (lunch number). If you are an adult or homeschooled, you may not have an ID number yet. If this is the case, please enter "none yet."
Is this address temporary living arrangements?
Is this due to economic hardship?

School Information

Which school is the student enrolled in?
If other, please tell us the name of the school.
Is the student homeschooled?
Which grade will the student be in for the upcoming school year?
Does the student understand the plan to be followed in case school is dismissed prior to regular time for emergency or inclement weather?

Permissions

Does the student have permission to go on school-related walking field trips?
Does the student have permission to participate in school fundraisers?
James Rumsey Technical Institute has my permission to use photos & video recordings of my student for media and online publications.

Guardians

Please provide information for up to four guardians including parents, adults living in the same home as the student, and anyone who will serve as emergency contacts.


Guardian 1

Address Line 1
Address Line 2
City
State
Zip

Guardian 2

Address Line 1
Address Line 2
City
State
Zip

Guardian 3

Address Line 1
Address Line 2
City
State
Zip

Guardian 4

Address Line 1
Address Line 2
City
State
Zip

Family Information

Languages spoken at home by the family (if other than English)

Please provide the names of other children living in the home as well as their grade levels and which school they attend.

Is there a child custody agreement? If so, please provide JRTI with a copy of the agreement.

Medical Information

Please separate with a comma.
Please separate with a comma.
Please separate with a comma.

Statement of Insurance

Boards of education, James Rumsey Technical Institute and technical instructors do not carry accident insurance on students. Accident insurance is for the personal protection of the individual.

All students attending James Rumsey Technical Institute are required to have accident insurance.