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School District: Black Hawk Area Special Education District
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Start Registration for New Student(s) at Black Hawk Area Special Education District
Step 1 of 3
Please start the registration process by entering your student’s information:
*First Name:
*Last Name:
*Birth Date:
*Address 1:
Address 2:
Address 3:
*City, State, Zip:
 
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
AS
FM
GU
MH
MP
PR
PW
VI
AB
BC
MB
NB
NF
NS
NT
NU
ON
PE
QC
SK
YT
OT
 
*School:
Phoenix Program
ACHIEVE
Black Hawk Area Education Center
*Grade Level Entering:
*required field
Add Parent/Guardians
Step 2 of 3
Please enter the contact information for existing and/or new parent/guardian(s)
Please enter the contact information for custodial parent/guardian(s) (emergency contacts are added later):
*First Name:
*Last Name:
*Email:
*Relationship:
Mother
Father
Mother, step
Father, step
Grandmother
Grandfather
Aunt
Uncle
Sister
Brother
Guardian
Medical Care Provider
Agency Representative
Foster parent
Probation Officer
Minister or Priest
Other/Unknown
Mentor
Neighbor
Friend
Rabbi
Babysitter
Employer
Brother, half
Brother, natural/adoptive
Brother, step
Cousin
Daughter
Father, foster
Father, natural/adoptive
Husband
Mother, foster
Mother, natural/adoptive
Nephew
Niece
Significant other
Sister, half
Sister, natural/adoptive
Sister, step
Son
Ward
Wife
Adopted son
Adoptive parents
Advisor
Brother-in-law
Court appointed guardian
Daughter-in-law
Dependent
Former husband
Former wife
Family member
Father's significant other
Father-in-law
Fiancé
Fiancée
Foster daughter
Foster son
Granddaughter
Grandson
Great aunt
Great uncle
Life partner
Life partner of parent
Mother's significant other
Mother-in-law
Partner
Partner of parent
Sister-in-law
Son-in-law
Stepson
None
Sibling
Case Worker
Child Care
Foster Family
Grandparent
Live-in Companion
Parent
Adopted Daughter
Father's Civil Partner
Godparent
Great Grandparent
Half Brother
Half Sister
Mother's Civil Partner
Other
Relative
Stepdaughter
Spouse
Stepparent
Unknown
*Phone
Number:
*required field
Confirm Information
Step 3 of 3
Confirm your information:
Student(s):
Parent/Guardian(s):