Student Enrollment Information

Transcription

1 Student Enrollment Information Milton High School Birmingham Highway Milton, GA Phone: Fax: o Required Paper work from previous school: WITHDRAWAL FORM (Unless transferring during the summer) COPY OF TRANSCRIPT (With complete mailing address of school last attended) ATTENDANCE RECORD DISCIPLINE RECORD o Required paperwork from Parent/Guardian: o VERIFICATION OF RESIDENCY Need one document from List A and one document from List B A. One document must be from the list below with the parent or guardian s name and current address: Copy of home mortgage bill Valid Driver s License/State ID Copy of home sale contract Section Eight/HUD Housing Document Homeowner s/renter s Insurance registration card Current bank statement Current Paycheck Current HOA Bill Current Apartment/House Lease B. One document must be from the list below with the parent or guardian s name and current address: Current Water bill Current Electric bill Current Gas Bill o IMMUNIZATION RECORDS - Georgia Immunization Certificate (form 3231 Rev. 7/2014). (contact the North Fulton Regional Health Center at ) o CERTIFICATE OF VISION, HEARING, DENTAL, AND NUTRITION SCREENING (form 3300 Rev. 2013) (contact the North Fulton Regional Health Center at ) o SOCIAL SECURITY CARD o BIRTH CERTIFICATE state issued (hospital certificates not acceptable) o PROOF OF CUSTODY- if you are NOT the natural parents (contact the Probate Court at ) o IEP OR 504 PLAN if applicable

2 For School Use: Entry Date: / / Grade Assigned: Homeroom/Advisement: FULTON COUNTY SCHOOLS STUDENT ENROLLMENT FORM SIS-1 Revised 04/14 FORM #113 (1)STUDENT INFORMATION Print All Information Clearly. Circle One In This Group: SEX: M - Male Student's Last Name First Name Middle Name Generation (ex. JR,III) F - Female / / Is this student Hispanic/Latino? (Choose only one) Preferred Name Month/ Day /Yr of Birth Student's Social Sec. # No, not Hispanic/Latino Home Address: Street # and Name P.O. Box if App. Apt. # City Zip +4 Home Phone: ( ) Complex/Subdiv.Name: 2 - Asian Yes, Hispanic/Latino What is the student's race? (Choose one or more) 1 - American Indian or Alaska Native 3 - Black or African American School system of residence if other than Fulton: RESTRICT DIRECTORY INFORMATION? Y N 4 - Native Hawaiian or Other Pacific Islander County of residence if other than Fulton: 5 - White Name of School Serving area in which student lives: (2)PARENT/GUARDIAN INFORMATION (Complete a box for each parent, step-parent, or guardian; add page if necessary) Name: Name: Name: Last First MI Suff. Last First MI Suff. Last First MI Suff. Home Address & Phone If Different From Student's Home Address & Phone If Different From Student's Home Address & Phone If Different From Student's Address: Address: Address: City/State/Zip+4: City/State/Zip+4: City/State/Zip+4: Home Phone: ( ) Home Phone: ( ) Home Phone: ( ) Alt/Cell Phone: Alt/Cell Phone: Alt/Cell Phone: Occupation: Occupation: Occupation: Business Name: Business Name: Business Name: Business Address: Business Address: Business Address: City/State/Zip+4: City/State/Zip+4: City/State/Zip+4: Business Phone: ( ) Business Phone: ( ) Business Phone: ( ) Circle Relation to Student: Mother,Father, Stepmother, Circle Relation to Student: Mother,Father, Stepmother, Circle Relation to Student: Mother,Father, Stepmother, Stepfather, Legal Guardian,Other Stepfather, Legal Guardian,Other Stepfather, Legal Guardian, Other Contact w/student is allowed? Y N Contact w/student is allowed? Y N Contact w/student is allowed? Yes No Resides with this parent/guardian? Y N Resides with this parent/guardian? Y N Resides with this parent/guardian? Yes No Parent/guardian is responsible for student? Y N Parent/guardian is responsible for student? Y N Parent/guardian is responsible for student? Yes No Works for federal gov't or on federal property? Y N Works for federal gov't or on federal property? Y N Works for federal gov't or on federal property? Yes No (3)MEDICAL/EMERGENCY INFORMATION (4)ENROLLMENT INFORMATION Family Physician Has student ever attended a Fulton County School? Yes No First/Last Name: Physician's Phone: ( ) ext. If no, Non-Ful.Co. prior school name: Insurance/Health Coverage: City & State of prior school: Note medical problems, medication requirements, life-threatening allergies, and other special instructions: Enrolled from / / to / / If yes, give name of school(s):

3 Date first entered a USA School (mm/dd/yy) The persons below have authorization to pick-up my child during school hours and can be reached at the numbers listed. FirstName,LastName Phone Number Ext. Relationship Chk out of School? Entry Codes: (Circle One) ( ) Y N C Continue in same school W Admitted under SB10 ( ) Y N U From within system X Admitted under USCO List Siblings in THIS school: T From another GA public school A From a home school O From another state or country N Never attended school (5) REQUIRED INFORMATION P From a private school S Re-entry after illness Active Military Yes No B Previously WD from this school & year I Re-entry after incarceration V Admitted under School Choice R Re-entry other Active Military indicates whether the student has a parent or guardian who is active in US Armed Forces, including the National Guard or Reserve Forces. (7)FOR SCHOOL USE ONLY (6) MANDATORY FOR ALL STUDENTS To provide your child with the best possible education, we need to determine how well he or she speaks and understands English. This survey assists school personnel in deciding whether your child may be a candidate for additional Immunization Code (Circle One) Student has met the following requirements: English language support. Final qualification for language support is based E - Medical Exemption Ear Exam Yes No on the results of an English language assessment. N - GA Requirements Not Met Eye Exam Yes No R - Religious Exemption Dental Exam Yes No **Which language does your child most frequently speak at home? (Primary/Native Language)? W - 30-Day, 90-Day, 180-Day Waiver Emer.Sig.Card Yes No **Which language do adults in your home most frequently use when speaking with your child? Follow-up Date: / / Birth Certificate Yes No (Home Language)? **Which language(s) does your child currently understand or speak? Y - GA Requirements Met (Correspondence Language)? Has student ever received services in the following programs? High School Course of Study/Graduation Track * Valid only if student entered 9th grade prior to 2009 Gifted Yes No EIP Yes No Title I Yes No ESOL Yes No Circle One: **Valid only if student entered 9th grade in 2009 or Remedial Ed Yes No Homeless Yes No B - Both College Prep. And Career Tech* later 504 Yes No C - College Preparatory Spec. Educ. Yes No If Yes, Area D - College Prep w/distinction Date 1st entered 9th grade (mm/dd/yy): / / Other Programs (Specify) H - Career Tech Prep.** M - College Prep & Career Tech Prep w/distinction PreK Program Attended: Circle One N - College Prep w/distinction & Career Tech. Prep 1. GA PK-Public School 5. Private Non-Profit PK Q - College Prep & Career Tech w/distinction 2. Public Sponsored PK (Title1) 6. Private For-Profit PK S - Special Education 3. Head Start 7. Did not attend PK U - Career Tech Prep w/distinction 4. Other Public School 8. GA PK-Private School Hardship Student (Circle one) Childcare, Curriculum, Moving,Employee, Medical, Adm.Placement High School Only: I have received a student handbook. Magnet Program Student (Circle one) Student Signature: Art/Science, Math/Science International Studies, Visual & Performing Arts, International Studies Tuition PARENT SIGNATURE:

4 ENROLLMENT DECLARATION Milton High School Birmingham Highway Milton, GA Student Name: Last First Middle Date of Birth Grade Current Address: Phone Number: TO BE COMPLETED BY PARENT: Is the student currently on suspension or expulsion from another school or school system? No Yes If YES, give reason(s): Terms of Suspension: Has the student ever been convicted of a felony crime (armed robbery, aggravated assault or battery, rape, carrying a deadly weapon, felony drugs, kidnapping, arson, murder, hijacking, etc.)? No Yes If YES, date of conviction: Offense(s) committed: Name and Location of Court: Sentence Imposed: NOTE: A STUDENT MAY BE WITHDRAWN FROM SCHOOL IF FALSE INFORMATION IS PROVIDED Georgia Law If a transferring middle/high school student does not bring a certified copy of his/her academic transcript and disciplinary record from the school previously attended by the student, a new Georgia law (OCGA ) provides "... a transferring student may be admitted on a conditional basis if he or she and his or her parent or legal guardian executes a document providing the name and address of the school last attending and authorizing the release of all academic and disciplinary records to the school administration... and shall also disclose on the same document as the release whether the child has ever been adjudicated guilty of the commission of the designated felony act as defined in Code Section and, if so, the date of such adjudication, the offense committed, the jurisdiction in which such adjudication was made, and the sentence imposed The student or his or her parent or legal guardian shall also disclose on the document whether the student is currently serving a suspension or expulsion from another school, the reason for such discipline and the term of such discipline. If a student so conditionally admitted is found to be ineligible for enrollment pursuant to the provisions of Code Section , or is subsequently found to be so ineligible, he or she shall be dismissed from enrollment until such time as he or she becomes so eligible." Parent Signature Date

5 Milton High School Birmingham Highway (770) Milton, GA Fax (770) REQUEST FOR STUDENT RECORDS Student s Name: Date of Birth: Previous School: Current Grade: School Address: City State Zip Code The above named student has enrolled in our school. Please forward the following information to Milton High School: Official transcript Please indicate how many points are added to Honors, AP/IB, and/or College grades Withdrawal Grades Explanation of Grading Scale Immunization Records Standardized Test Records Discipline Records Attendance Records Special Education Records (including IEP, Psychological and Evaluation Reports) ESOL records I Authorize Release of These Records. Parent/Legal Guardian Signature According to the Final Regulations Family Educational Rights and Privacy Act (Buckley Amendment) dated June 17, 1976, it is not longer necessary to obtain written consent from parent to release records between schools. It states that school officials in the school system in which the student may intend to enroll may receive a student s records without written consent for such release. Records Requested By: Date

6 INFORMATION FOR GETTING IMMUNIZATION RECORDS TRANSFERRED TO GEORGIA FORMS North Fulton Regional Health Center 3155 Royal Drive, Suite 125 Alpharetta, GA Hours: Monday Friday 8:30 am 5:00 pm (highly suggested to get there before 2:30 pm) No Appointment necessary Services available for a fee Transfer of immunizations to GA certificate( form 3231 Rev. 7/2014) Ear, Eye, Dental & Nutritional Certificate (form 3300 Rev. 2013) and Screening Immunizations NO SHOTS = NO SCHOOL Please protect your child against measles, mumps, polio, rubella, whooping cough, diphtheria, hepatitis B and chicken pox, Meningococcal and Tdap (Tetanus with Pertussis)x. Call your family doctor or the health center nearest you.

7 Effective July 1, 2014, all 7 th grade students who were born on or after January 1, 2002 and for new entrants grades 8-12 who are entering into a Georgia school for the first time or entering after having been absent from a Georgia school for more than twelve months or one school year will be required to have: 1 Dose of Tdap (Tetanus, Diphtheria, Pertussis Vaccine) AND 1 Dose of Meningococcal Conjugate Vaccine A new Certificate of Immunization Form 3231 (Revised 7/2014) will be required for students to register for school. The new 3231 Certificate of Immunization Form will be available and all community providers and health departments should have access to the form and to GRITS (The Georgia Registry of Immunization Transactions and Services). Proof of both vaccinations must be documented on the Georgia Immunization Certificate (Form 3231). Certificates issued prior to July 1, 2014 can either be the old form 3231 (Revised 3/2007) or the new form (Revised 7/2014) but it must show proof of the two vaccinations unless the child has an exemption. You must check for these vaccines, even if the certificate is marked complete. If the Certificate is marked complete and the child does not have these vaccines, he/she must return to his primary care provider or public health center to receive the vaccines and a new/updated certificate. For more information, visit or call (800) PLEASE NOTE: These changes only affect rising 7 th graders (born on or after January 1, 2002), and students who are considered new entrants for grades 8-12.

8 Georgia Department of Public Health Form 3300 Certificate of Vision, Hearing, Dental, and Nutrition Screening FILE THIS FORM WITH THE SCHOOL WHEN YOUR CHILD IS FIRST ENROLLED IN A GEORGIA PUBLIC SCHOOL SCREENER CONTACT INFORMATION IS REQUIRED Parent/ Guardian Name: first middle last Parent/ Guardian Contact Information: Daytime phone number: Evening phone number: Cell phone number: VISION Unable to screen (explain why below) Uses corrective lenses Worn for testing Passed (20/30 in each eye for age 6 and above, 20/40 in each eye for below age 6) Needs further evaluation Under professional care (explain below) Screening completed by: Physician Local Health Department Optometrist Prevent Blindness Georgia employee School Registered Nurse HEARING Unable to screen (explain why below) Uses hearing aid / assistive device Passed at 500, 1000, 2000, and 4000 Hz with audiometer at 20 or 25 db Needs further evaluation Under professional care (explain below) Screening completed by: Physician Local Health Department Audiologist Speech-Language Pathologist School Registered Nurse Child s Name: first middle last Date of Birth: / / Gender: Male Female Child s Home Address: street city state zip code county DENTAL Unable to screen (explain why below) Normal appearance Needs further evaluation Emergency problem observed Under professional care (explain below) Screening completed by: Physician Dentist Local Health Department Registered Nurse Registered Dental Hygienist School Registered Nurse PLEASE SEE THE INSTRUCTIONS ON THE BACK OF THIS FORM NUTRITION Unable to screen (explain why below) Height: Weight: BMI: BMI%: 5 th to 84th percentile - Appropriate for age < 5 th percentile - Needs further evaluation 85 th percentile - Needs further evaluation Under professional care (explain below) Screening completed by: Physician Local Health Department Registered Dietician School Registered Nurse Screener s Signature Date I certify that this child has received the above screening. Contact Information: Screener s Signature Date I certify that this child has received the above screening. Contact Information: Screener s Signature Date I certify that this child has received the above screening. Contact Information: Screener s Signature Date I certify that this child has received the above screening. Contact Information: FOR SCHOOL SYSTEM ONLY Follow up for further evaluation 1 st attempt 2 nd attempt Actions reported (if any) Vision Hearing Dental Nutrition Student support services initiated on: Screeners Comments: DPH Form 3300 Rev. 2013

9 Georgia Department of Public Health Form 3300 Certificate of Vision, Hearing, Dental, and Nutrition Screening Who is required to file this Form 3300? The parent or guardian of a child who is being admitted for the first time to a public school in Georgia must file a completed Form 3300 with the school when the child is enrolled. What is the purpose of Form 3300? Form 3300 is intended to make sure that every child in Georgia is screened for possible problems with their vision, hearing, teeth and nutrition. The earlier these problems are detected, the earlier parents can seek professional help for the child. What screenings are required? Four different screenings are required: vision, hearing, dental, and nutrition. All four screenings must be conducted and reported on the form before it can be filed with the school. Who can conduct the screenings? Your child s doctor is authorized to conduct all four screenings, as is your local health department. In addition, the vision screening can be conducted by a Georgia licensed optometrist, an employee of Prevent Blindness Georgia trained to conduct vision screening, or a school registered nurse; the hearing screening can be conducted by a Georgia licensed speech-language pathologist or audiologist, or a school registered nurse; the dental screening can be conducted by a Georgia licensed dentist, dental hygienist, or a school registered nurse; and the nutrition screening can be conducted by a Georgia licensed dietician or a school registered nurse. It is not necessary that the same person conduct all four screenings. What does BMI and BMI% mean? BMI means body mass index. BMI is a way to describe how much a child weighs in relation to height. BMI percentile is a way to compare the child s body mass index to the body mass index of a healthy child. If the child s BMI is less than 5% or more than 84% of what is appropriate for his or her age and height, then the child should be taken to a doctor or dietician for a more detailed evaluation. For more information, visit the Centers for Disease Control and Prevention website on child and teen BMI at: What should a parent do if the needs further evaluation box is checked? Needs further evaluation means that the child may have a problem. If the needs further evaluation box is checked, then the parent should take the child to a professional for a more detailed evaluation. Your doctor or local health department may be able to help, or recommend someone who can help. What if a Form 3300 was previously filed for the child at another school? It is only necessary to file the Form 3300 once. If the Form 3300 is filed at the child s first school, and the child later transfers to another school, then the original school is required to forward the Form 3300 to the new school.

10 Georgia High School Graduation Test All Students who wish to graduate from a public high school in the state of Georgia must pass all five sections of the Georgia High School Graduation Test (GHSGT). Mark with an X each section of the GHSGT that you have passed. We will also need proof of a passing grade, which should transfer with the records from your previous school. Science Social Studies Mathematics English/Language Arts Writing Or I have not passed any sections of the GHSGT Student Signature: Parent Signature:

11 Honors Points Added to Transfer Grades The Q&A on Honors Points and the EOCT includes the following statement about transfer grades: Will honors points be added to the grades of students who transfer into Fulton County from other school systems? No, the grades of transfer students will be recorded just as we receive them; we will not add honors points to their honors or AP grades. Many school systems have already added points to their students grades and it is not possible for us to determine who has and has not already received honors points. Revision to the Stated Procedures as of 10/15/2004: Because most systems who weigh honors, AP and IB courses add the points to the grade that appears on the transcript, we will not add honors points to a transfer student s grades unless the parent or guardian produces an official school system document or a notarized statement on school system letterhead that speaks to how honors points were or are given during the entire time the student was enrolled in the system. When this documentation is presented, seven (7) points will be added to each honors, AP or IB course using the same procedures we use for our students. It is not the responsibility of the counseling staff at the receiving school to seek information from the sending school about this matter. If a school system uses a grading scale where a D is a and, consequently, credit is awarded, the seven (7) points will be added to honors, AP and IB courses BEFORE any other conversion is made. For example, if the student presents a 64, the grade to be recorded will be a 71. If the student presents a 62, adding seven (7) points make the grade a 69 and we convert to a 70 which is the lowest passing grade we can record. I have read the Honors Points Added Transfer Grades Policy Sign: Date:

12 GEORGIA HIGH SCHOOL ASSOCIATION P. O. Box 271, Thomaston, GA FAX: TRANSFER STUDENT ELIGIBILITY - FORM B (Revised June, 2012) INSTRUCTIONS: This form may NOT be handwritten, and must be submitted for each student who has transferred to your school in the past twelve months from the date of the student transfer. WARNING: Falsification of data on this form may result in institutional penalties such as fine and/or forfeitures of contests. It could result in the student being declared ineligible for any competition for a period of up to two years. It also could result in the transmission of a report of the falsification to the Professional Standards Commission if certified personnel were involved in the falsification. SECTION A DATE OF THE STUDENT TRANSFER ACTIVITY SCHOOL CITY SCHOOL YEAR In-state Transfer Out-of-state Transfer NAME LAST FIRST MIDDLE Approved Foreign Exchange: Program (Complete Section A and B Only) DATE OF BIRTH DATE STUDENT ENTERED 9 TH GRADE Mo. Day Year Mo. Day Year UNITS EARNED Prev Semester TOTAL UNITS EARNED (This Column for GHSA use only) ELIGIBILITY STATUS Beginning & Ending Dates Attended Beginning with 9 th Grade (Give month, day, year) Grade Name of School Address (City, State) SECTION B - General Transfer Information Present Home Address: (Street) (City, State) (County) Lives With: (Names) Previous Home Address: (Relationship) (Street) (City, State) (County) Persons Student Lived with at Previous Address: (Names) (Relationship) Is the current residence located in your school service area? Is the custodial parent a certified teacher, counselor or administrator at the receiving school (Grades 9-12)? Was the student suspended or expelled (or facing such penalties) at the former school? (If yes, attach additional information) Does the student qualify for a waiver due to a joint custody or a custody change? (If yes, attach court documents, including judge's signature) SECTION C - Family and Residential Information (Complete only if a bona fide move is claimed) CURRENT RESIDENCE: Is the current residence being: purchased; leased; rented? Do you claim multiple residences? If Yes, do you claim a Homestead Exemption on this residence? PREVIOUS RESIDENCE: Have you relinquished your previous residence? If "Yes", how was it relinquished? rented previously; sold residence or have a contract for sale; residence listed for sale at fair market value; abandoned the house with unnecessary utilities shut off; leased/rented residence at a fair market value. If Yes, is the residence being leased/rented to a family member?. If Yes, please list that individual and relationship:. VERIFICATION OF THE BONA FIDE MOVE: (Completed by school personnel) Accepted the word of the parent/guardian. Conducted a site visit - if "Yes", who made the visit? Received documentation via utility bill, post office documentation, driver's license, etc. - if "Yes", what document? (Signed - Principal / Asst. Principal / AD) (Signed Report Preparer) (Date)