Welcome to Latta Public Schools

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1 Welcome to Latta Public Schools Pre-K-4 th Online Enrollment Packet Forms Included: Enrollment Form Student Health Inventory Form Student Enrollment Questionnaire Home Language Survey Tribal Membership Form School Calendar Online Enrollment Information Online forms can be used by any current/returning students. Download the PDF and print out the forms. Complete the filling out of the forms prior to enrollment day. Bring the complete forms along with any necessary paperwork on the day of enrollment. Example: new immunizations Parent must attend enrollment.

2 Latta Public Schools PreK-12 Enrollment Form EL MS HS Home of Panthers Office Use Only Student UID Student State ID Birth Certificate Immunizations Records Received School Entry Date: I. Student Information 1. (LEGAL NAME ONLY) Last Name Middle Name Suffix (Jr, II, III) 2. Grade: 3. Birth Date 4. Birth Place (, State) 5. Gender Male Female 7. Previously enrolled in School--if yes: Grade School Name: : State: 10. Language(s) Spoken at Home 8. Is student of Hispanic or Latino culture or origin? 11. Student's Primary Language 6. Social Security Number 9. Race (Check all that apply): White/Caucasian Native Hawaiian or Other Pacific Islander Black or African American Asian American Indian or Alaska Native Tribal Affiliation: CDIB: Card No. 12. Home Address 13. Mailing Address (if different than home address) State/Zip Code State/Zip Code 14. Resident Transfer 15. Has student attended Latta Schools previously? 16. 6th-12 Grade Student Cell Phone II. Parent and Emergency Contact Information 17. Parent/Guardian Last Name Lives with Relation to Student Address student Student's Legal Home Address (if different than Box 12) Guardian Place of Employment State/Zip Code Custody Mailing Address (if different from home address) State/Zip Code Pickup Rights Other Parent/Guardian Primary Phone Work Phone Cell Phone Last Name Lives with Relation to Student Address student Student's Legal Home Address (if different than Box 12) Guardian Place of Employment State/Zip Code Custody Mailing Address (if different from home address) State/Zip Code Pickup Rights Primary Phone Work Phone Cell Phone Latta School Enrollment Form Page 1

3 18. Local Emergency Contact #1 (Other than Parent/Guardian listed above) II. Parent and Emergency Contact Information (continued) Last Name Relation to Student Primary Phone Work Phone Cell Phone Local Emergency Contact #2 (Other than Parent/Guardian listed above) Last Name Relation to Student Primary Phone Work Phone Cell Phone III. Student Information 19. People Prohibited From Picking Up Student Last Name Relationship 20. Siblings Attending Latta Public Schools Last Name Grade Relationship 21. Student Transportation Car Rider Walker L.E.A.D.S Bus Rider Bus # Student Driver 22. Please check all of the following that the student is enrolled. Speech Therapy Gifted/Talented Special Education (IEP) Title-Math or Reading Latta School Enrollment Form Page 2

4 Last Name Has your student ever had chicken pox? Age: Latta Public Schools IV. Student Health Inventory Gender Male Female Grade Check the following health concerns that pertain to student: Allergies To Drugs Food Insect Pollen Etc? List Has the allergy required emergency action in the past? Bee Sting Allergy Difficulty breathing? Need emergency care? Epi-Pen Asthma Inhaler? How Often? Dr. Name Diabetes Take Insulin Date Diagnosed Epilepsy/Seizures Date of last seizure Medication Is the student currently under a doctor's care for seizures? Heart Condition Describe Any physical restrictions? Medications: Bone/Joint Condition Any physical restrictions? Describe: Eyes--check all that apply: Ears--check all that apply: ADD/ADHD Difficulty Seeing Glasses (reading or distance) Contacts Crossed Eye Lazy Eye Frequent Infections Tubes Hearing Difficulty Hearing Aid: R L Wears at school Medication at school? Medication at home? Other Health Concerns or Problems: Circle all that are a concern. Blood Pressure Dental Eating Headaches Lungs Menstruation Neurologic (brain) Nosebleeds Phobias Sleeping Skin Bladder/Bowel Requires catheterization Bedwetting Requires diapering Daily medication at home? Name of medications and reason for taking List serious illness, disease, or injuries. List all Surgeries Signature of parent/guardian Address Phone # (home) (work) Latta School Heatth Enrollment Form

5 Latta Public Schools Student Enrollment Questionnaire Student Name: Date of Birth: Grade: Today's Date: School: Your child may be eligible for additional educational services through Title X, Part C McKinney-Vento Assistance Act. Eligibility can be determined by completing this questionnaire. Where are you and your family currently living? Please check one of the boxes below. Section A: Rent/own my own home or apartment STOP: If you checked the box that you rent/own your own home or apartment skip to the bottom of the page, sign the form, and then submit to school personnel. If you do not rent/own your own home or apartment, please continue to the next section. Section B: Temporarily with another family member or friend until we can locate affordable housing In an emergency or transitional shelter In a vehicle, park, campground, or on the streets In a house, building, or trailer WITHOUT running water or electricity In a hotel or motel With an adult that is not a parent or legal guardian Alone or in different locations, without an adult serving as a caregiver Wherever I can find a place to stay at night Other, Please Explain: If you checked a box in section B, in the space below please list all children living with you who attend Latta Public Schools. First and Last Name of Student Male or Female Date of Birth Grade School Name Would you like to be contacted by an employee of the school to discuss additional educational services that may be available to your child? YES NO The undersigned certifies that the information provided is correct and accurate. (Print) Parent/Guardian or Adult Caring for the Student: Relationship to the Student: Signature: Street Address State Zip Phone Number: Address: Latta School Student Enrollment Questionnaire

6 Name of Student: Joy Hofmeister State Superintendent of Public Instruction Oklahoma State Department of Education HOME LANGUAGE SURVEY FOR PRE-K-12 SCHOOL DISTRICTS Last Name Middle Name Student ID #: Gender: Male Female School Site: Grade: Date of Birth: Place of Birth (/State/Country): Is the student of Hispanic or Latino culture or origin? Select one or more of the following races: African American/Black American Indian/Alaskan Native Asian Native Hawaiian or Other Pacific Islander Caucasian/White Parent s/guardian s Name: Parent s/guardian s Address: Parent s/guardian s Telephone Number: ( ) Cell Phone: 1. Is a language other than English used in your home? If NO, go to numbers 6 and 7. If YES, what is that language? 2. Is that language spoken in the home MORE OFTEN than English? LESS OFTEN than English? 3. What language is spoken by adults in the home? 4. What was the first (1 st ) language your child learned to speak? 5. What was the date (month and year) your child first enrolled in a school in the United States? 6. Parent/Guardian Signature: 7. Date: OR Street Zip Code FOR SCHOOL USE ONLY THIS FORM MUST BE COMPLETED EVERY YEAR WITH CURRENT TEST DATA FOR STATE ACCREDITATION. If a language other than English is spoken MORE OFTEN (see question #2), the student automatically qualifies as bilingual on application for accreditation. If a language is spoken LESS OFTEN, student qualifies as bilingual on application for accreditation if he or she meets ONE OF THE FOLLOWING: 1. Scores 35% or below on norm-referenced test (NRT) on the composite reading score. 2. Scores limited knowledge or unsatisfactory on Reading Oklahoma Core Curriculum Tests (OCCTs). 3. Designated Limited English Proficient on an Oklahoma English language proficiency assessment: WIDA ACCESS for English language learners (ELLs) Test, WIDA Placement Test (including K W-APT, W-APT, and Kindergarten MODEL), or the Oklahoma Pre-K Language Screening Tool. Documentation of a test result for students who marked LESS OFTEN: 1. NRT Test Date: Name of the NRT: Reading Total Composite Score: 2. Reading OCCT Date: Score on Reading OCCT: Limited Knowledge Unsatisfactory Satisfactory Advanced 3. ACCESS for ELLs Test Date: Score on ACCESS for ELLs: 1 2 WIDA Placement Test (K W-APT, W-APT, or Kindergarten MODEL) Date: Score on K W-APT, W-APT, or MODEL: 1 2 Oklahoma Pre-K Language Screening Tool Date: Score on Pre-K Language Screening Tool: Note: Have test score documentation available for regional accreditation officer review. 1 2

7 Latta Public Schools County Road 1560 Ada, OK Dear Parent/Guardian: Year: Latta Public Schools would appreciate your cooperation in a school-wide survey of Native American students. All parents/guardians (Indian and Non Indian) are asked to complete this survey and return it to any school office as soon as possible. Students who have Indian blood, who can name the tribe, who can provide the name of the individual with tribal membership, and complete a 506 form with parent signature, can be counted in our Title VII program. This program provides funds for many school projects, supplies, and equipment. Our school receives district benefits because of the number of Indian students we can count. Please take a few moments to help your school. Sincerely Cliff Johnson Superintendent STUDENT S NAME GRADE DATE My child has some Indian blood, but no CDIB card. Please list Tribe/Band /Group name and individual with membership. Tribe/Band/Group Name Individual s Name The parent has a CDIB card, but the child does not. TRIBE My child has a CDIB card. TRIBE My child has no Indian blood. (Do not fill out the 506 form.) Latta School Tribal Membership Form

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