BONNIE WILKINSON ELEMENTARY SCHOOL REGISTRATION REQUIREMENTS

Transcription

1 BONNIE WILKINSON ELEMENTARY SCHOOL REGISTRATION REQUIREMENTS 2013~2014 THE FOLLOWING DOCUMENTS MUST BE PRESENTED AT THE TIME OF REGISTRATION 1. CHILD'S BIRTH CERTIFICATE- The child you are registering must be 5 years of age on or before Sept 1,2013. FOR PREKINDERGARTEN-your child must turn 4 years of age on or before Sept 1, CIDLD'S SOCIAL SECURITY CARD- Please bring your child's card so a copy can be made. If your child does not have a Social Security Card then a State PEIMS number will be assigned. 3. PROOF OF RESIDENCY A current utility bill, lease agreement or buyer's agreement with parent/guardian's name and address. 4. CHILD'S IMMUNIZATION RECORDS: SHOTS REQUIRED TO START SCHOOL 4-5 DPT (one must be after 4th birthday) 3-4 IPV (one must be after 4th birthday) 2 MMR (both must be after 1 5t birthday) 3HEPB 2 VARICELLA (Chicken Pox) (both must be after 1 st birthday) or proof ofdisease 2 HEP A (both must be after 1 st birthday) HIB-PK only (1 dose required, must be after 15 months ofage) Pneumococcal (Prevnar) PK only - (1 dose required, must be after 2 years ofage) 5. PARENT/GUARDIAN DRIVER'S LICENSE Ifyour child has attended a school outside ofthe Conroe lsd, please provide us with the name and address ofthe school and your child's last report card from that school. We are excited your child will be attending Bonnie Wilkinson Elementary School for the school year. Ifwe may be of any assistance to you please feel free to call us at

2 Parents: Please complete back of form (page 21. CONROE INDEPENDENT Please complete front AND BACK of this page. SCHOOL DISTRICT Teacher: check one: I r No-show first day lorir' Present first day And Teacher initials Registration Form - New Students Bonnie Wilkinson Office Entry : Campus No: Elementary School Use Grade: Homeroom: 2575 Ed Kharbat Only Zone Code: Zone Reason: Campus: Conroe. TX I Student Name Sex: Birth : Student ID#: PEIMS#: Student resides with: 0 mother Dfather D both 0 other Name: Phone:(home) (workl Guardian addresses: ,--,- Student's Physical Student's Mailing Address: street address dty zip Other parent/guardian information if applicable: Name: Phone:(home) (work) Physical Address: street address city zip Other Parent/Guardian ;lrklrp«p" Waming: It is a criminal offense pursuant to Texas Penal Code for a person to knowingly falsify information on a form required for a student's enrollment in the District. This is such a form. Parent/guardian signature required for enrollment of student. Si es necesario por favor pedir la forma en espano!. Iam aware that in order for my child to attend school in the Conroe lsd, my child must meet the district's residency requirements or be granted an approved Interdistrict transfer. Iacknowledge that I have read and understand the penalties of falsified information as stated in the Texas Education Code (h) printed below. I also agree to inform the proper school authorities immediately, should I move from the address indicated. Proof of residency is required. Texas Education Code : h.ln addition to the penalty provided by of the Penal Code, a person who knowingly falsifies information on a form required for enrollment of a student in a school district is liable to the district if the student is not eligible for enrollment in the district but is enrolled on the basis of the false information. The person is liabl.e, for the period during which the ineligible student is enrolled, for the greater of: 1) the maximum tuition fee the district may charge under of this code; or 2) the amount the district has budgeted for each student as maintenance and operating expenses. I hereby certify one of the following! ajprimary guardian is a resident (managing conservator or legalguardianls), blother legal parent Is a resident (possessory conservator), clstudent signing form Is at least 18 years of age and a resident of the district, or dlstudent has been granted an approved Interdistrict transfer. I understand that one of these conditions must be maintained In order for the student to attend the Conroe ISO. Ialso agree to inform the proper school authorities Immediately, should I move from the address indicated above. With my signature I acknowledge that I have read and verify the information on this registration form, and that I understand the penalties of providing falsified Information as stated above. Parent/Guardian Signature In order to meet Texas Education Agency's recommended guidelines, CISD is using social security numbers for the required PEIMS Reporting Number. If you choose not to provide this information, please provide the District's Legal Department with written objection within ten days of the issuance of this notice. The Conroe Independent School District does not discriminate on the basis of race, color, national origin, sex, religion, age. or disability in its admissions policies, or by excluding from participation in, denying access to, or denying the benefits ofdistrict services, academic and/orvocational and technology programs, or activities as required by Title VI and TItle VII of the Civil Rights Act of as amended, Title IX of the Education Amendments of 1972, the First Amendment of the United States Constitution, the Age Discrimination Act of 1975, Section 504 of the Reha bilitation Act of as amended, and TItle II ofthe Americans with Disabilities Act. I For information about Title IX rights. contact the Title IX Coordinator, 3205 W Davis, Conroe, Texas 77304; (936) For information about Section 504/AOA rights. contact the Section 504/ADA Coordinator, 3205 W Davis, Conroe, Texas 77304; (936) Parents should forward any medical information, anergies, or medical problems to the attention of the campus. Administrative Enrollment: PEIMS (4/10) Administrator or Diagnostician/Speech Therapist's signatureltitle front (page 1 )

3 Conroe Independent School District (170902) Office Use Only Campus Name Student's legal Name Campus Number Please fill out the following information for all schools in which this student was previously enrolled. StudentlD# Name of School District or City & State in which Name of School school is located School Telephone # (s) of Enrollment Grade(s) Student's address while attending this school - I I I, '--- L... ~- -- back (page 2)

4 Conroe Independent School District Student Residency Questionnaire The information on this form is required to meet the law kuown as the McKinney-Vento Act 42 U.S.C a(2), which is also kuown as Title X, Part C, of the No Child Left Behind Act. The answers you give will help the school determine the services the student may be eligible to receive. Presenting a false record or falsifying records is an offense under Section 37. J0, Penal code, and enrollment ofthe child under false documents subjects the person to liabilityfor tuition or other costs. TEe Sec (3)(d). Name of Student: Gender: 0 Male 0 Female Last First Middle Birth : --:...1_--:...1 Campus: Month I Day I Year Student ID#:, Check the box that best describes with whom the student resides. (Please note: legal guardianship may be granted only by a court; students living on their own or with friends or relatives who do not have legal guardianship are allowed to enroll in and attend school. The school cannot require proofofguardianship for enrollment or continued attendance.) o Parent(s) o Legal Guardians( s) o Caregiver(s) who are not legal guardian(s) (Examples: friends, relatives, parents offriends, etc.) o Other Name of person with whom student resides: Address: City: ZIP:, Home Phone #: Cell Phone #: Other Emergency #:...:.- Length oftime at Present Length oftime at Previous Address: Name of the school where student is enrolled or in which student is attempting to enroll: Last District Attended: Last School Attended: Please check only one box that best describes where the student is presently living: o In my own home or apartment, in Section 8 housing, or in military housing with parent(s), legal guardian(s), or caregiver(s) (ifyou checked this box, check one or both ofthe boxes below, ifapplicable:) (CODE=N) o My home has no electricity (CODE=U) o My home has no running water (CODE=U) o In the home of a friend or relative because I lost my housing (examples: fire, flood, lost job, divorce, domestic violence, kicked out by parents, parent in military and was deployed, parent(s) in jail, etc.) (CODE=D) o In a shelter because I do not have permanent housing (examples: living in a family shelter, domestic violence shelter, children/youth shelter, FEMA housing) (CODE=S)

5 o In transitional housing (housing that is available for a specific length oftime only and is partly or completely paid for by a church, a nonprofit organization, or another organization) (CODE=S) o In a hotel or motel (examples: because ofeconomic hardship, eviction, cannot get deposits for permanent home, flood,fire, hurricane, etc.) (CODE=HM) o In a tent, car, van, abandoned building, on the streets, at a campground, in the park, or other unsheltered location (CODE=U) o None ofthe above describe my present living situation Briefly describe your situation: Factors contributing to the student's current living situation (check all that apply): o Natural disaster o Tornado, storm, flood, etc. o Hurricane, name: o Fire: prairie, forest, grass, lightning strike, etc. o Family issues such as divorce, domestic violence, kicked out by parents, student left due to family conflict, etc. o Home issues such as lack of electricity, water, heat, adequate home repair due to lack of funds, overcrowding, mold, etc. o Military: Parent/guardian deployed, injured or killed in action o Incarceration ofparent/guardian o Incapacitation ofparent or guardian due to health, mental health, drugs/alcohol, or other factors o Home fire not due to natural causes (Le.,faulty equipmentiappiiances/wiring,jurnace, stove,fireplace, etc.) o Economic hardship: o Loss ofjob resulting in inability to pay rent or mortgage o Income from part-time or low paying job does not cover cost ofhousing in the area o Loss ofmortgage, including loss ofmortgage oflandlord ifstudentlstudent's family is renting o Eviction record and/or inability to produce deposits for rent or utilities o High medical bills that leave little or no money for housing o Lack ofaffordable housing in the area o Minor student unable to afford housing on my own o None ofthe above describe the main reasons for my present living situation fado~: Briefly explain the contributing Please provide the following information for school-age siblings (brothers and/or sisters) ofthe student: Name Grade Level School District Signature ofparentilegal GuardianlCaregiverlUnaccompanied Student For School Use Only I certi:ly the above named student qualifies for the Child Nutrition Program under the provisions ofthe McKinney-Vento Act. McKinney-Vento Liaison Signature

6 Form 1 HLS Home Language Survey - Registrar Initial Enrollment CONROE INDEPENDENT SCHOOL DISTRICT Home Language Survey (Fecha): Campus (Escue/a): Name of Student (Nombre de/ estudiante):, Address (Domicilio): ID# (Numero de identificaci6n): Grade (Grado): *This form should be filled in and signed by parent or guardian for PK-8 students, or by the student in Grades (Este formulario debe completarlo y firmarlo el padre! madre 0 tutor legal de los estudiantes que cursan los grados de prekindergarten a octavo 0 por el estudiante en los grados superiores). *Refer to Chapter What language is spoken in your home most of the time? l,cua/ es e/ idioma que mas se habla en su hogar? What language does your child speak most of the time? l,cual es el idioma que mas habla su hijo(a)? What language does your child speak and understand best? iqwa idioma habla y entiende mejor su hijo(a)? Has your child lived outside the United States for 2 or more consecutive years? iha vivido su hijo/a ruera de los Estados Unidos por dos 0 mas anos consecutivos? How long has your child lived in the United States? t- Cuanto tiempo ha vivido su hijo/a en los Estados Unidos? Has your son/daughter changed school districts within the last 3 years? ise ha cambiado su hijo/a de distrito escolar durante los ultimos 3 anos? Did your child attend school regularly in the United States or his/her native country? t-asisti6 su hijo/a can regularidad ala escuela en los Estados Unidos 0 pais de origen? Yes, my child attended school regularly in the United States or in my country of origin and finished the previous grade. S!, mi hijo/a asisti6 con regularidad a la escuela en los Estados Unidos 0 en mi pais y terrnin6 sus grados escolares anteriores. No, my child did not attend school regularly in the United States or in my country of origin and did not finish the previous grade as stated below. (Specify the grade, month and year your child failed to attend school. Do not include if absences were less than a month.) No, mi hijo/a perdi6 una gran parte de uno 0 mas anos escolares, como se especifica abajo.(especifique el grado y el periodo en que su hijo/a no asisti6 a la escuela, incluyendo el mes y el ano. No incluya el tiempo que su hijo/a no asisti6 a la escuela si fue menos de un mes.) Signature of Parent (Firma del padre/madre 0 tutor legal): 04/11 Original - Cumulative Folder Yellow Green Folder Pink At-Risk Counselor

7 HH...,..H... New Studentlnlormation Conroe Independent School District Campus: ~ : Student's name: Age: of birth: Grade: StudentDD#: Yes No Has your child ever been enrolled in a Conroe Independent School District school before?... If yes, /lame ofschoo/(s): Has your child ever repeated a If yes, which grade(s)?: o Check Yes or NQ to indicate whether your child has ever received services in any of the following programs: Special Education, including Speech Therapy.... Special Reading or Math program (not in Special Education).... H H H......H.... Migrant program... c o Bilingual/ESL program.... Gifted and Talented program... Section o [J Please note that official testing or other academic documentation may be required for your child to qualify in the Conroe Independent School District for any of the special programs marked "Yes". PEIMS 7/06

8 School Bus Registration Form Please complete the following information to ensure access to transportation service. Without prior registration, your student may not be able to ride the school bus until proper registration has been received by the Transportation Department. (Print Information) : Campus: Student's Name: Will student be riding the school bus in? o Always DSometimes ONO (fill in blank with school year) Please check orp/ace an X in the appropriate box Complete the student information below ONL Y if your student will n!'led to ride the school bus. Birth : Age: Sex: Grade:_lyr Home Address: Parent/Guardian Name: Phone: Work Phone: Emergency Contact: (when parent or guardian can not be reached) Name: I.\ddress, Relationship to student: Phone: Parent/Guardian Signature: Hoja de inscripcion para el servicio de trans porte escolar Favor de lienar con la informacion solicitada para garantizar el acceso a los servicios de transporte. Si el estudiante no esta inscrito en el servicio de transporte, no podra hacer uso del servicio. Solamente podra utilizarlo una vez que el Departamento de Transporte haya recibido esta solicitud. (Favor de usar letra de molde) Fecha: Escuela: Nombre del estudiante: l,viajara en autobus durante el alio escolar DSiempre D Algunas veces ONO (Poner ano escolar en el espacio vaclo) Favor de tacher con una.x" la opci6n apropiada L1ene con la informacion solicitada SOLO si el estudiante va a viajar en autobus. Fecha de Nacimiento: Edad: Sexo: Grado:_laiio -- Direcci6n de la casa: Nombre del padre 0 tutor: T elmono del trabajo: T elmono del trabajo: Persona a quien IIamar en caso de emergencia si el padre 0 tutor no estan disponibles. Nombre: Direccion del contacto: Parentesco con el estudiante: Telefono: Firma del padre 0

9 Texas Education Agency Texas Public School Student/Staff Ethnicity and Race Data Questionnaire The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff. This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC). School district staff and parents or guardians of students enrolling in school are requested to provide this information. If you decline to provide this information, please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting. Please answer both parts of the following questions on the student's or staff member's ethnicity and race. United States Federal Register (71 FR 44866) Part 1. Ethnicity: Is the person Hispanic/Latino? (Choose only one) D Hispanic/Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. D Not Hispanic/Latino Part 2. Race: What is the person's race? (Choose one or more) 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 a tribal affiliation or community attachment. D 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. D Black or African American A person having origins in any of the black racial groups of Africa. D Native Hawaiian or Other Pacific Islander A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. D White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. StudentlStaff Name (please print) (ParentlGuardian)/{Staff) Signature StudentlStaff Identification Number This space reserved for Local school observer - upon completion and entering data in student software system, file this form in student's permanent folder. Ethnicity - choose only one: Race - choose one or more: American Indian or Alaska Native Hispanic / Latino Asian Black or African American Not Hispanic/Latino Native Hawaiian or Other Pacific Islander White Observer signature: Campus and : Texas Education Agency - Marc:..;:h-=-2::.0=-1.:...:0' J

10 ID Verification of Adult Information Student Name: LocallD: Full Name of Adult Enrolling Above Named Student: First Name MI Last Name Address of Adult Enrolling Above Named Student: Lot and Street City State Zip Code of Birth of Adult Enrolling Above Named Student: MonthlDaylY ear Signature Today's PEIMS: 7/06

11 Wilkinson Elementary Policy for Grade Placement In addition to the fonns required for registration, Wilkinson Elementary must be provided with the most recent school records showing classroom grades and assessment infonnation. Please read the following excerpts from the Conroe Independent School District's board policy (FD Local). Placement (Accredited Schools) The parent, guardian, or other person having lawful control of a student enrolling in a District school from an accredited public, private, or parochial school shall provide evidence of the prior schooling outside the District. The student shall be placed initially at the grade level reached elsewhere, pending observation by the classroom teacher, guidance personnel, and the principal. On the basis of these observations and results of the tests that may be administered by appropriate District personnel, the principal shall detennine the final grade placement. For the purposes of this policy, "accredited" shall be defined as accreditation by TEA, an equivalent agency from another state, or an accrediting association recognized by the Commissioner. Placement (Nonaccredited Schools) A student enrolling in a District school from a nonaccredited public, private, or parochial school, including a homeschool, shall be placed initially at the discretion ofthe principal, on a probationary basis, pending observation by classroom teachers, guidance personnel, and the principal Criteria for placement may include: 1. Scores on achievement tests, which may be administered by appropriate District personnel 2. Recommendation of the sending school. 3. Prior academic record. 4. Chronological age and social and emotional development ofthe student. S. Other criteria deemed appropriate by the principal. I have read the policy from Conroe ISD above and understand that I must provide records about my child(ren)'s previous schooling. I also understand that the principal at Wilkinson Elementary may change my child(ren)'s placement in accordance with this policy. Student Name Parent/Guardian Signature Relationship to Student