requirements for regK - Salem Public Schools
Transcripción
requirements for regK - Salem Public Schools
Salem Public Schools City of Salem Parent Information Center __________________________________________________________________________________ 29 Highland Avenue, Salem, Massachusetts 01970 (978) 740-1225 Fax (978)740-1176 Registration Document Checklist In order to properly register your child for school, you must provide the Parent Information Center with the following documents: Required Forms Assignment Application Form (please complete & sign) Home Language Survey Household Information Survey, and Acknowledgement Form Birth Certificate (one of the following documents) § Child’s birth certificate (original or certified copy) § Passport § I-94 Card § Resident Alien Card Immunization Records (Please provide your child's most recent physical examination and immunizations. If your child has an appointment during the summer, send a copy of the updated information to PIC attention Paula Dobrow, RN. By law, children cannot be admitted to school until the documentation has been received). Medical Information Sheet & Emergency form Proof of Parent/Guardian’s Identity – provide one of the following: § Massachusetts Driver’s License, § Massachusetts Photo ID § Passport Proof of Address in Salem (two of the following documents) § Lease or mortgage statement in parent’s/guardian’s name, current electric, gas, cable, water, or telephone bills in parent’s/guardian’s name § If you do not have any utilities under your name and you reside with a family member or friend: please provide a notarized letter from the person you live with and two proofs of address under that person’s name. Special Education Individualized Educational Plan (IEP), if applicable 504 Plan, if applicable Proof of address Residency fraud is a violation of Massachusetts state law and is subject to per diem fines for every day that a student attends school outside the district in which s/he legally resides. Legal guardianship Legal guardianship requires additional documentation from a court or agency. Homeless families The McKinney-Vento Act requires schools to enroll homeless children and youth immediately, in the absence of the normally required documents, please talk to a PIC staff member. Escuelas Públicas de Salem Ciudad de Salem Centro de Información para Padres __________________________________________________________________________________ 29 Highland Avenue, Salem, Massachusetts 01970 (978) 740-1225 Fax (978)740-1176 Lista de Verificación para Inscripción Para matricular a su niño/a en la escuela, debe proveer al Centro de Información para Padres los siguientes documentos: Documentos Requeridos Aplicación de Asignación (completada y firmada) Encuesta del Idioma Hablado en el Hogar Encuesta de Información Familiar y Forma de Reconocimiento Acta de Nacimiento (uno de los siguientes documentos) § § § § Certificado de nacimiento (original o copia certificada) Pasaporte Tarjeta I-94 Tarjeta de residencia Vacunas (incluya el examen físico y las vacunas más recientes de su hijo. Si su hijo tiene una cita durante el verano, envíe una copia de la información actualizada a Paula Dobrow, RN. Por ley, los niños no pueden ser admitidos a la escuela hasta que la documentación haya sido recibida). Hoja de Información Médica & Formulario de Emergencia Prueba de Identidad del Padre/Tutor (uno de los siguientes documentos) § Licencia de conducir de Massachusetts § Identificación con foto de Massachusetts § Pasaporte Prueba de Dirección en la Ciudad de Salem (dos de los siguientes documentos) § § Arrendamiento o estado de hipoteca en nombre de los padres/tutor, factura de electricidad, gas, cable, agua, o teléfono a nombre de los padres/tutor Si usted no tiene ninguna prueba de dirección bajo su nombre y vive con un familiar o amigo/a: Necesitamos una carta de la persona con quien vive, certificada por un notario, acompañada de dos pruebas de dirección con el nombre de esa persona. Plan Educacional Individualizado (PEI), si aplica Plan 504, si aplica Comprobante de domicilio El fraude de residencia es una violación a las leyes estatales de Massachusetts y está sujeto a multas diarias por cada día que un estudiante asista a una escuela fuera del distrito en el cual él/ella reside legalmente. La tutela legal La custodia legal requiere documentación adicional de un tribunal o agencia. Familias sin hogar La Ley McKinney-Vento ordena que las escuelas matriculen a niños y jóvenes sin hogar de inmediato, aún si no posee los documentos normalmente requeridos, por favor hable con un miembro del personal del Centro de Información para Padres. Salem Public Schools City of Salem ______________________________________________________________________________________________________________" 29"Highland"Avenue,"Salem,"Massachusetts"01970" """"""""""""""""""""(978)"740?1225""""""""Fax"(978)740?1176" Acknowledgement Eligibility for Free/Reduced Price Meals: How Information Will Be Used Parent Name:____________________________ Student Name: _____________________________ I acknowledge and agree to release to the Salem Public Schools’ Parent Information Center and further acknowledge and agree that the Salem Public Schools’ free and reduced price meals officials may give to the Salem Public Schools’ Parent Information Center information concerning my child’s eligibility or non-eligibility for price meal benefits. I acknowledge and agree that the Salem Public Schools’ Parent Information Center may use this information to help determine the placement of my child. I understand that both the Salem Public Schools’ and I free and reduced price meals officials will be releasing eligibility information to the Salem Public Schools’ Parent Information Center from the Price Meal Benefit Form for my child. I give up my rights to confidentiality for this purpose only. I understand that I am not required to release this information and that my declining to sign this form will not affect my child’s eligibility and participation for price meal benefits or non-eligibility for price meal benefits. I understand that if I elect not to release this information, the Salem Public Schools’ Parent Information Center will consider my child non-eligible for free and reduced price meals only for purpose of determining school placement for my child. ! I am choosing to release my eligibility for free or reduced price meal benefits and am attaching a copy of our meals application. ! I am electing not to release this information and/or my family is not eligible for this benefit. I have read this release and understand its terms and sign it voluntarily. ___________________________________ Parent/Guardian Signature ___________________________________ Date Please Note: This voluntary disclosure is used in the registration process only. When your child begins school, you must submit your formal application for the federal free and reduced price lunch program and be determined to be eligible to receive free or reduced price meals. " Home Language Survey Massachusetts Department of Elementary and Secondary Education regulations require that all schools determine the language(s) spoken in each student’s home in order to identify their specific language needs. This information is essential in order for schools to provide meaningful instruction for all students. If a language other than English is spoken in the home, the District is required to do further assessment of your child. Please help us meet this important requirement by answering the following questions. Thank you for your assistance. Student Information First Name Middle Name Country of Birth / / Date of Birth (mm/dd/yyyy) F Gender Last Name M / / Date first enrolled in ANY U.S. school (mm/dd/yyyy) School Information / /20 ______ Start Date in New School (mm/dd/yyyy) Name of Former School and Town Current Grade Questions for Parents/Guardians What is the native language(s) of each parent/guardian? (circle one) Which language(s) are spoken with your child? (include relatives -grandparents, uncles, aunts,etc. - and caregivers) (mother / father / guardian) seldom / sometimes / often / always (mother / father / guardian) What language did your child first understand and speak? seldom / sometimes / often / always Which language do you use most with your child? Which other languages does your child know? (circle all that apply) Which languages does your child use? (circle one) speak / read / write speak / read / write Will you require written information from school in your native language? Y N Parent/Guardian Signature: X seldom / sometimes / often / always seldom / sometimes / often / always Will you require an interpreter/translator at Parent-Teacher meetings? Y N / Today’s Date: /20 (mm/dd/yyyy) Salem Public Schools City of Salem Parent Information Center _______________________________________________________________________________________ 29 Highland Avenue, Salem, Massachusetts 01970 (978) 740-1225 Fax (978)740-1176 HOUSEHOLD INFORMATION SURVEY Please complete, sign and return this application to the address above. IF ANY MEMBER OF YOUR HOUSEHOLD RECEIVES M A S N A P o r M A T A F D C b e ne f i t s , PROVIDE THE AGENCY IDENTIFICATION NUMBER* LOCATED ON THE DEPARTMENT OF TRANSITIONAL ASSISTANCE (DTA) BENEFIT LETTER. Then proceed to Section 4. If no one receives these benefits, start with Section 1. Name:___________________________________________________ 10-Digit Case Number:________________________________ INSTRUCTIONS: Complete this survey and return to your child’s school or mail to the address listed above. These selections must be completed by the Head of Household or Designee 1. 2. SIZE OF FAMILY - Indicate the total number of individuals living in your household, including all adults and children:_______ STUDENT INFORMATION - Complete for each student Pre-K through 12th grade Last Name First Name Birth Date MM-DD-YY School Identify H if Homeless M if Migrant R if Runaway F if Foster 1. 2. 3. 4. 5. 6. 7. 8. If you need additional lines, attach a second sheet to this survey or attach a copy of this survey clearly marked as Page 2 3. TOTAL MONTHLY HOUSEHOLD INCOME – Report Income for all members of household excluding foster children. If you have reported a case number above, you do not need to complete this section; proceed to section 4. Circle if Type of Income Income No Income 1. Gross Monthly Earnings: Wages, Salary, Commissions $ None 2. Monthly Welfare Payments, Child Support, Alimony $ None 3. Monthly Payments from Pensions, Retirement, Social Security $ None 4. Monthly Dividends or Interest on Savings $ None 5. Monthly Worker’s Compensation, Unemployment, Strike Benefit $ None 6. Other Monthly Income (SSI, VA, Disability, Farm, other) $ None Total Monthly Household Income (Add lines 1-6) 4. $ SIGNATURE I certify (promise) that all information on this application is true and that all income is reported. I understand the school will be eligible for certain federal and/or state funds based on the information I give. Sign Here: X________________________________________________ Address Home Phone For Office Use Only: Circle One Print Name:______________________________________ Date____________________ City Zip Code Work Phone QUALIFIES QUALIFY Email Address: DOES NOT By providing your email address, you may be contact via email by the district PROCESSED BY: Salem Public Schools - Assignment Application - Carlton Continuous Progress Program Date of Application:__________ School Year: 2015-2016 Date of Enrollment: Winter Trimester Spring Trimester Student Information Child’s Full Name: ________________________________________________________________________ First Full Middle Last Address: __________________________________________________________________ Grade Entering: Kindergarten Apt. #: ____________ Male Female Place of Birth:__________________________________________________________________ Date of Birth: _____________________ City Country If born in another country, date of arrival in USA: ______________________________________________________________________________ Name of Day Care or Pre-K Program attending: _______________________________________________________________________________ City/State:________________________________________________________ Has your child ever attended the Salem Early Childhood Center? No Last day attended: ___________________________________ Yes years? __________________________________ Parent/Guardian Information I am the child’s Parent Legal Guardian E-mail: _________________________________ Home Phone: _________________________ Mother’s Name: _________________________________________ child lives with Yes No Mobile Phone: _______________________ Father’s Name: __________________________________________ child lives with Yes No Mobile Phone: _______________________ Guardian’s Name:______________________________________________________ Parent’s address, if different from student’s:_______________________________ Relationship: _________________________________ Home Phone: ____________________________________ Ethnic/Racial Group: Primary Home Language Hispanic or Latino: Yes No AND check all that apply: English Spanish Vietnamese Portuguese Albanian Asian American Indian or Alaskan Native Russian Black White Other________________ Hawaiian/Pacific Islander In which language would you prefer your school notification sent? ______________________ Is student receiving special services? Yes No Is student receiving the following services? Title 1 LEP (English Lang. Learner) Medical Concerns/Daily Medications (If not in violation of confidentiality) Special Circumstances: Yes Member of Military Family Date of Birth ______________________________ ______________________________ ______________________________ My Household qualifies for Free/Reduced Lunch Yes Special Circumstances: Migrant IEP 504 Plan No _________________________________________________________________________ Homeless Siblings: Name ________________________________ ________________________________ ________________________________ If Yes Refugee No Other: _____________________________________ School Attending __________________________ __________________________ __________________________ Grade ____________ ____________ ____________ Staff Initials ________ Homeless Other: ________________________________________________ Would you like information about the Parent-Child Home Program for 2 and 3 year olds? Yes No Parent’s signature:___________________________________ Office Use Only SCHOOL ASSIGNMENT: PROGRAM: SASID# SIBLING ATTENDING CARLTON: Yes ___ No ___ PROXIMITY TO SCHOOL: FREE/REDUCED LUNCH: Yes ___ No ___ LANGUAGE EVAL: Yes ___ No ___ FREE TRANSP.: Yes ___ No ___ NOTE: Salem Public Schools School Health Services Dear Parent / Guardian, Massachusetts State Law, Chapter 76, s. 15 requires that all children receive these immunizations before the first day of Kindergarten. Your child’s health records for Kindergarten entry must contain: _____ Physical Examination (must be within 6 months of entering school) All immunizations _____ DTP #1 #2 #3 #4 _____ Polio #1 #2 #3 #4 _____ MMR #1 #2 _____ Hepatitis B #1 #2 _____ Varicella #1 #2 #5 #3 _____ or physician’s documentation of having had chicken pox disease _____ Lead Test ____ Health Questionnaire ______Vision Screening including stereopsis screening Please contact your health care provider to schedule the required physical and/or immunization visit(s). Vaccines are available, free of charge, at the Lydia Pinkham Clinic, 250 Derby Street, Salem, MA on Tuesday and Thursday afternoons from 1 PM until 4 PM. All health forms must be reviewed by the school nurse before the start of Kindergarten. Children will not be allowed to be in school until the documentation has been received. If you have any questions, please contact your school nurse. Please submit any health information completed during the summer to the Parent Information Center at Collins Middle School, 29 Highland Ave, attention Paula Dobrow, RN. Thank you for your prompt attention. Paula J. Dobrow, RN, MSN Director of Nursing and Health Services 978-825-5500 Salem Public Schools City of Salem Parent Information Center _______________________________________________________________________________ 29 Highland Avenue, Salem, Massachusetts 01970 (978) 740-1225 Fax (978) 740-1176 Dear Parent(s), We wish to welcome you and your child to the Salem Public Schools! This packet contains a kindergarten application and related materials for the Carlton Innovation School Continuous Progress Program. We ask that you complete this information and return it to the Parent Information Center. All assignments to Carton Elementary School will follow the Salem School Committee’s Assignment Policy. School assignments are based on the information you provide to us via these materials. We hope that the following information helps to answer some of your questions about the registration process. With regard, Stephen Russell, Ed.D. Superintendent How do I enroll my child in the Salem Public Schools? Submit a kindergarten assignment application to the Parent Information Center. An assignment application is enclosed along with an addressed return envelope. Enrollment is a three-step process: Step 1. Step 2. Complete all forms in the kindergarten packet and submit the required documents. Upon receipt of your child’s assignment, please confirm assignment by sending the confirmation form back to PIC. Step 3. You and your child must attend Kindergarten screening. What is the deadline to submit application? In order for siblings to have priority you must submit your application by February 20th to receive this preferred status. Any other applications must be received by March 1st. How will parents be notified? Parents will be notified by mail of whether or not their child was assigned or place on a waiting list by May 1st. Please do not call the Parent Information Center or Carlton School regarding kindergarten assignments before the notification dates. What documents do I need to submit with my application? Proof of address (two of the following documents): Lease or mortgage statement in parent’s/guardian’s name: current electric, gas, cable, water, or telephone bills in parent’s/guardian’s name. If you do not have any utilities under your name and you reside with a family member or friend: We need a notarized letter from the person you live with and 2 utility bills under that person’s name. Parent’s photo ID Household Information Survey & Acknowledgement Form Proof of Child’s Age (One of the following documents): Child’s birth certificate (original or certified copy) Passport, I-94 Card or Resident Alien Card Immunization Records Please provide your child's most recent physical examination and immunizations. Special Education Individualized Educational Plan (IEP) or 504 Plan, if applicable How will students be selected? Students entering Salem Public Schools are assigned according to our Controlled Choice Student Assignment Policy: 1) Programmatic placements 2) Sibling preference (if submitted by February 20th) 3) Choice and Free and reduced Lunch Status When is kindergarten screening? Kindergarten screening will take place at the Carlton Elementary School before each trimester entry. Parents will be contacted by the school to set up appointments. If you need more information you may contact the Parent Information Center (978) 740-1225 What is the age requirement for this program? The Carlton Innovation School will admit Kindergarten students three times during the school year. Please see the chart below for age requirement: Fall Trimester Winter Trimester Spring Trimester All Kindergarten students who are 5 years by August 31st All Kindergarten students who are 5 years old between September 1st and November 30th All Kindergarten students who are 5 years between December 1 and February 28th If assigned, will my child be able to ride the school bus? Transportation will be provided if you meet the distance criteria determined by the School Committee’s transportation policy. For questions regarding transportation please contact the Transportation Department at (978) 740-1138. What if my child has a medical condition? If your child has a health condition such as asthma, diabetes, allergy to food or bees, seizure disorder, cystic fibrosis, bleeding disorder or other health concern, please contact the nurse at your assigned school as soon as possible to plan for his/her care that may be necessary during the school day. Questions or concerns during the summer can be directed to Paula Dobrow, RN, at (978) 825-5500. SALEM PUBLIC SCHOOLS SCHOOL HEALTH SERVICES MEDICAL INFORMATION SHEET Student’s Name:______________________________________ Date of birth:_______________ Parent/Guardian Name:__________________________________________________________ Address: _____________________________________________________________________ Phone:________________________________ Cell: ____________________________________ Parent/GuardianName:___________________________________________________________ Address: ______________________________________________________________________ Phone: __________________________________Cell: __________________________________ Pediatrician: ______________________________________ MD Phone: ___________________ Dentist: ___________________________________________DMD Phone: _________________ Prescribed Medications: ______________________________________________________ Health Insurance Name: _______________________________________________________ Does your child have any allergies? _________YES _______ NO If yes, please specify: Foods: _______________________________________ Insects/Bees: ____________________ Medicines: __________________________ Animals: ___________________________ Seasonal/environmental allergies: ______________ Other: ____________________________ Allergy medication used: _____________________________________________ Describe any reaction; include date(s) of reaction(s): ______________________________________________________________________________ ______________________________________________________________________________ What treatment was given to your child? ______________________________________________________________________________ Has your child ever been given an Epi-‐Pen? ________Does your child have an Epi-‐Pen?______ Has your child been seen by an allergist, if so when:____________________________________ Allergy doctor:_______________________________________Phone:_____________________ Does your child have any health conditions? ________YES ________ NO asthma Nebulizer ______ yes ______ no Inhaler ______ yes ______ no ________YES ________ NO headaches ________YES ________ NO constipation ________YES ________ NO heart condition ________YES ________ NO sickle cell ________YES ________ NO diabetes ________YES ________ NO ADHD ________YES ________ NO urinary tract infections ________YES ________ NO bedwetting ________YES ________ NO seizures ________YES ________ NO food intolerances ________YES ________ NO short attention span ________YES ________ NO temper tantrums ________YES ________ NO celiac disease ________YES ________ NO hearing difficulty hearing aid? ______yes ____no ________YES ________ NO difficulty seeing wear glasses? ______ yes ____ no ________ YES ________ NO speech problems Has your child ever been hospitalized or had surgery? ______yes ______ no If yes, please explain_____________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Is there anything else you think we should know about your child? Salem Public Schools City of Salem __________________________________________________________________________________ 29 Highland Avenue, Salem, Massachusetts 01970 (978) 740-1225 Fax (978)740-1176 Registration Document Checklist In order to properly register your child for school, you must provide the Parent Information Center with the following documents: Assignment Application form (please complete & sign) Home Language Survey Free and Reduced Price Meals Application, Acknowledgement Form & Materials Birth Certificate (one of the following documents) § Child’s birth certificate (original or certified copy) § Passport § I-94 Card § Resident Alien Card Proof of parent/guardian’s identity – provide one of the following: § Massachusetts Driver’s License, § Massachusetts Photo ID § Passport Immunization Records Proof of address in Salem (two of the following documents) § Lease or mortgage statement in parent’s/guardian’s name, current electric, gas, cable, water, telephone bills in parent’s/guardian’s name § If you do not have any utilities under your name and you reside with a family member or friend: please provide a notarized letter from the person you live with and two proofs of address under that person’s name. Transfer card from previous school, if applicable Special Education Individualized Educational Plan (IEP), if applicable 504 Plan, if applicable Proof of address Residency fraud is a violation of Massachusetts state law and is subject to per diem fines for every day that a student attends school outside the district in which s/he legally resides. Legal guardianship Legal guardianship requires additional documentation from a court or agency. Homeless families The McKinney-Vento Act requires schools to enroll homeless children and youth immediately, in the absence of the normally required documents, please talk to a PIC staff member. Escuelas Públicas de Salem Ciudad de Salem __________________________________________________________________________________ 29 Highland Avenue, Salem, Massachusetts 01970 (978) 740-1225 Fax (978)740-1176 Lista de Verificación para Inscripción Para matricular a su niño/a en la escuela, debe proveer al Centro de Información para Padres los siguientes documentos: Aplicación de Asignación (completada y firmada) Encuesta del idioma hablado en el hogar Aplicación para almuerzo gratis o reducido, Formulario de Reconocimiento & Materiales Acta de nacimiento (uno de los siguientes documentos) § Certificado de nacimiento (original o copia certificada) § Pasaporte § Tarjeta I-94 § Tarjeta de residencia Prueba de identidad del padre/tutor (uno de los siguientes documentos) § Licencia de conducir de Massachusetts § Identificación con foto de Massachusetts § Pasaporte Historial de Vacunas (cartilla con las vacunas actualizadas) Prueba de dirección en la ciudad de Salem (dos de los siguientes documentos) § Arrendamiento o estado de hipoteca en nombre de los padres/tutor, factura de electricidad, gas, cable, agua, o teléfono en nombre de los padres/tutor. § Si usted no tiene ninguna prueba de dirección bajo su nombre y vive con un familiar o amigo/a: Necesitamos una carta de la persona con quien vive certificada por un notario, acompañada de dos pruebas de dirección con el nombre de esa persona. Tarjeta de transferencia de la escuela anterior, si es aplicable Plan Educacional Individualizado (PEI), si es aplicable Plan 504, si es aplicable Comprobante de domicilio El fraude de residencia es una violación a las leyes estatales de Massachusetts y está sujeto a multas diarias por cada día que un estudiante asista a una escuela fuera del distrito en el cual él/ella reside legalmente. La tutela legal La custodia legal requiere documentación adicional de un tribunal o agencia. Familias sin hogar La Ley McKinney-Vento ordena que las escuelas matriculen a niños y jóvenes sin hogar de inmediato, aún si no posee los documentos normalmente requeridos, por favor hable con un miembro del personal del Centro de Información para Padres. Salem Public Schools City of Salem RELEASE OF STUDENT RECORDS In accordance with Massachusetts Department of Education Student Record Regulations (23:07(4)(8), please forward, as soon as possible, all academic records, standardized test scores, second language assessments, Special Education records, psychological reports, attendance, health behavior and discipline records, and any related information that may be helpful for the proper educational placement of this student. Massachusetts law requires that a transfer form must accompany these records. Date: ___________________________________________________ Student: ________________________________________________________ Date of Birth: ___________________________ Grade: ___________________________________ SASID# _________________________________________________________ (Previous) School Name: _________________________________________________________________________________ Address: ____________________________________________________________________________________________________ City, State, Zip Code: _______________________________________________________________________________________ Phone Number: ______________________________________ Fax Number: ___________________________________ Please forward records to: (New) School Name: ______________________________________________________________________________________ Address: ____________________________________________________________________________________________________ City, State, Zip Code: ______________________________________________________________________________________ Phone Number: ______________________________________ Fax Number: ___________________________________ RELEASE OF RECORDS AUTHORIZATION I hereby authorize the release of all records and reports pertaining to the above-‐mentioned student to the SALEM PUBLIC SCHOOLS. Parent/Guardian signature: ____________________________________________________________ Parent/Guardian printed name: _______________________________________________________ FOR OFFICIAL SCHOOL USE ONLY RECORDS REQUESTED Academic Records ________________________ Achievement Test Scores Date Request Forwarded MCAS Scores MEPA Scores Special Education Records ________________________ Attendance Records Date Records Received Health Records Discipline Records Other