Enrollment Forms Packet (EFP)

Transcription

1 Enrollment Forms Packet (EFP) Please review the information below. Based on your student(s) grade and applicable circumstances, you are required to submit documentation in order to complete this step in the enrollment process. You can fax, scan and , or mail the required paperwork. Important Note: Please send copies, do not mail the original documents Fax (preferred): Scan and Mail: Texas Virtual Academy 104 Industrial Blvd B-2 Sugarland, TX Required For? Item Description Provided by? Required for all Students Required for student with an IEP or other Special Education needs Required for students that have a 504 plan Proof of Age Official Birth Certificate (not the hospital issued certificate) Proof of Residency Immunization Record Current Utility bill showing service address OR Mortgage statement/rental contract including signature page OR recent tax statement Current Immunization Record Report Card The most recent Report Card Social Security Card Home Language Survey Migrant Student Survey Ethnicity Data Questionnaire Release of Records Withdrawal Intent Form IEP Evaluation Report 504 Accommodation Plan Please note do not send actual card, please submit a copy. Complete this form and submit. Complete this form and submit. Please write your student s name, as it was entered on the application. By filling out this form, you are giving our school permission to request your student s official records from their previous school after the approval process. If your child was Homeschooled please indicate it on the form, fill out the top portion and sign it. Complete this form and submit. A copy of your student s current IEP (Individualized Education Plan). Because the IEP expires yearly, please submit the current IEP. The Evaluation Report is valid for 3 years. If you do not have a copy of your student s ER, you can request a copy from your student s current school. A copy of your student s current 504 Accommodation Plan. Because the 504 expires yearly, please submit the current 504. Texas Virtual Southwest Enrollment Processing Center 104 Industrial Blvd, B-2 Sugar Land, TX Ph Fx v1.1

2 Texas Virtual Southwest Enrollment Processing Center 104 Industrial Blvd, B-2 Sugar Land, TX Ph Fx Release of Student Records Please accept this document as formal approval for the release of all official school records (including the record of transcripts, testing information, special education, health and immunization records). Student Information Student s Full Name: first middle last Student s Date of Birth: Student s Legal Address: street apt # city county state zip Home Phone: Homeschooled or Never Previously Enrolled in School (Fill out only if applicable) Check below if applicable: o Student was always previously homeschooled o Student is enrolling in Kindergarten Prior School Information Name of Prior School: School s Address: street city county state zip School s Phone: School s Fax: Sign and Date below Name of Parent or Legal Guardian: first last Parent/Guardian s Signature: Date: SCHOOL OFFICIALS ONLY: SCHOOL OFFICIALS ONLY: SCHOOL Send student OFFICIALS records ONLY: to: Send student records to: Send student records to: Texas Virtual Southwest 104 Industrial Blvd, B-2 Virginia Virtual Academy Washington Sugar Land, 2300 Corporate Virtual TX Academies Park Drive, Suite Herndon, McNeil Street, VA Suite 200 DuPont, WA Student s Name: Student s Home Phone:

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5 Southwest School 3333 Bering Drive Houston, TX Phone HOME LANGUAGE SURVEY Home Language Survey Encuesta a Sobre el Idioma del Hogar (PK-12) Student's Name: School: Nombre del alumno Escuela Student s Address: Home Phone. Domicilio Telefono de Casa Date of Birth: Grade: ID: Fecha de nacimiento Month Day Year Mes Dia Ano The Texas Education Code requires schools to determine the language(s) spoken at home by each student in order to provide an appropriate program of instruction. Please answer the following questions to help place your child in the most appropriate instructional program. El Codigo de Educacion de Texas requiere que las escuelas determinen el idioma que se habla en el hogar para identificar o proporcionar la instruccion apropiada para cada estudiante. Por favor conteste las siguientes preguntas para que podamos ayudarle a su hijo(a) en el programa mas apropiado. Place of Birth (Country of Origin) Lugar de nacimiento del estudiante Date of initial entry into U.S. schools Fecha en que el estudiante empezo sus estudios en los Estados Unidos City/Ciudad Country/Pais Month/Mes Day/Ano Year/Ano Has your family moved within the last 36 months to seek or do temporary work? Se ha mudado usted o un miembro de su familia en los ultimos 36 meses para buscar o hacer trabajo temporal? Yes No Number of academic years completed in a U.S. school Nurnero de anos escolares que ha completado el estudiante en los Estados Unidos 1. What Language is spoken in your home most of the time? Cual idioma se habla en su hogar la mayoria del tempo? English Spanish Other (Specify) Ingles Espanol Otro (Favor de especifcar 2. What language does your child speak most of the time? Cual idioma habla su Hijo(a) la mayoria del tiempo? English Spanish Other (Specify) Ingles Espanol Otro (Favor de especifcar Parent or Guardian/Firma del Padre(s) o guardian Date/Fecha FOR OFFICE USE ONLY / Solo para el uso de la oficina Note to school personnel: 1. File original of the Home Language Survey (HLS) in student s folder. 2. Send copy of the Home Language Survey (HLS) to the Bilingual/ESL Coordinator on the day the student enrolls.

6 MIGRANT STUDENT SURVEY ENCUESTA PARA MIGRANTES Dear Parent, Your children may qualify for supplemental services at Southwest School if they meet certain qualifications. To help us, please answer the following questions. Sus ninos pueden ser elegibles para servicios educacionales suplementarios en su distrito escolar si tienen cietos requistos. Para ayudarnos, por favor, conteste las siquientes preguntas. Student s Name: 1. Has your family moved any time during the last three years from one school district to another in Texas or across the state? Yes No Ha cambiado de Distrito Escolar durante los años passados? 2. Were any of these moves made to find temporary or seasonal work in agriculture related to a job in packing, processing, harvesting, cultivating of crops, food processing, dairy work, forestry, fishing, etc? Yes No Estos cambios fueron para buscar trabajo temporal en cualquiera de las siguientes industrias como en agricultura. empacadora, procesando, cultivando, o levantando cosechas, etc. Tambion procesando comida, trabajo de lecheria, trabajo forestall, o trabajo de pesca? Yes No If you answered yes to question # 2, please complete the information below. Name of parent or guardian: Phone # Address/ city/ zip Si contesta si a la pregunta # 2, por favor complete la informacion siguiente. Nombre del padre o guardian: Telefono: Direccion: Also list names and ages of children who are not enrolled in school. Por favor escriba nombres y edades de su hijo/ a que no edtan en la escuela. Age Last Name First Name Middle Name (Edad) (Apellido (Nombre) Segundo nombre) Thank you (Gracias) PARENT S SIGNATURE: DATE: (Firma de los padres) (fecha)

7 WITHDRAWAL INTENT FORM If I, (parent/guardian) should decide that TXVA is not the appropriate place for my student, my preferred educational intent to school will be the following: Home School Private School *Name of Public School (if this is the choice, this information must be completed and is not optional): Address: Phone Number: *Responsibility for compliance with state attendance statutes and regulations belongs to the parents, but the school is obligated to keep an accurate record of daily attendance. By statute, if a student is not meeting the statutory requirements for public school attendance, the student is considered truant under TEC This statute defines truancy as: *not being in attendance 10 or more days within a six-month period and/or *not being in attendance 3 or more days within a 4-week period As a truant student: 1. The student's parent or legal guardian is subject to prosecution under Texas Education Code The student is subject to prosecution under Texas Education Code A fine of $ may be assessed. Print Parent/Guardian Name: Parent/Guardian Signature: Date: 104 Industrial Blvd, B-2, Sugar Land, TX 77478, Ph , Fx , SY