2016-2017 STATE PRESCHOOL Registration Requirements
2016-2017 STATE PRESCHOOL Registration Requirements & Application EARLY BIRD REGISTRATION will begin on March 15, 2016 through April 29, 2016 QUALIFICATIONS – A CHILD MUST
● Turn four (4) years of age between December 3, 2015 & December 2, 2016 of the school year from July 1, 2016 to June 30, 2017 Your child’s birthdate must be between December 3, 2011 and December 2, 2012 ● Be toilet trained and be able to use the restroom independently ● Have a TB test & reading given after August 1, 2015 and be current with all immunizations ● Have a physical examination given after August 1, 2015 AND THE FAMILY MUST
● Live in Central Unified School District ● The applicant must be the adult who is responsible in providing the care & welfare for the preschooler ● Qualify by the State Guideline as listed in the table below - If over income, you will be denied ● Provide own transportation to and from school - No bus is available STATE INCOME GUIDELINES Effective 1-1-09-CDE – Management Bulletin 08-17 (Subject to Change)
Your family income must be at or below the state guideline listed below to qualify # of Persons in Family
1-2 3 4
Gross Monthly Income Family Yearly Income
$3,283.00 $3,518.00 $3,908.00
$39,396.00 $42,216.00 $46,896.00
# of Persons in Family Gross Monthly Income Family Yearly Income
5 6 7
$4,534.00 $5,159.00 $5,276.00
$54,408.00 $61,908.00 $63,312.00
PLACEMENT GUIDELINES
Placement into a class is based on your eligibility ranking, according to income and family size, established by the State of California;
Placement is NOT on a first come, first served basis First priority is given to Protective Service Children and At-Risk Children Second priority is given to those children whose birthdays are between December 2 and September 1 Priority of your child’s enrollment can change at any time depending on your eligibility and the eligibility of other families Applications received during Early Bird Registration (March 15, 2016 – April 29, 2016) will be given priority over applications received after April 29th. If your application is accepted and an opening is available, you will be contacted by phone or email to schedule an appointment to complete the Registration and Enrollment Paperwork If your application is not accepted after review, you w (1)byCOPY l beONE notified mail OF THE FOLLOWING DOCUMENTS MUST BE SUBMITTED WITH YOUR APPLICATION
Birth Certificates of ALL children (under 18) living in the home Proof of Address from Parent(s) Living With The Child – A copy of the most recent Utility Bill or Rental/Lease Agreement with prior month
receipt of payment to show that you are the responsible party in the care & welfare needs of the preschool child & siblings o If the above documents are not in your name, but you live with someone who owns the house and the utilities are in their name; the homeowner must complete and sign the attached Self-Declaration Under Penalty of Perjury form stating they are not responsible for the care & welfare needs of preschooler’s family and the Homeowner must provide a copy of their recent Utility Bill or Rental/Lease Agreement with prior month receipt of payment Preschool Child’s Immunization Record – Immunizations must be current along with a TB skin test & reading given after August 1st of last year Physical Examination – Must have been given after August 1st of last year. Have your child’s doctor provide you with a copy of the physical report or have the doctor complete the attached Physician’s Report form FOR CHILDREN LIVING WITH A GUARDIAN OR FOSTER PARENTS ONLY: Caregiver Affidavit – If child’s caretaker is a Foster Child and/or Guardianship Foster Parent’s Agreement (SOC 156) and/or court order “Appointing guardian of Minor & Certified Home Agreement” must be submitted and processed in the Student Support Services Department at Central Unified School District Office, 5652 W. Gettysburg Ave, Room 13. Please call 274-4700 ext. 63138, for any questions regarding the Caregiver Affidavit PRESCHOOL OFFICE ♦ 5652 W. Gettysburg, Room 10, Fresno, CA 93722 ♦ Phone (559) 274-4700 Ext 63199 ♦ Fax (559) 277-4527 1/16
Declaration Under Penalty of Perjury
(Declaration of Residency)
I _______________________________________am not responsible for the care and welfare Name of Owner of Home
for ______________________________________ and her/his child(ren) __________________ Name(s) of Preschooler’s Parent(s)
List Name(s) of Child(ren)
______________________________________________________________who live with me at _____________________________________________________________________________. Street Address
City
Zip Code
NOTE: Must bring current PG&E bill with the same name as listed above of owner of home and address with this form.
I declare under penalty of perjury that the above information is true and correct to the best of my knowledge. _________________________________
__________________________
Signature
Date
Declaración Bajo Pena de Perjurio (Declaración de Residencia)
Yo _______________________________________no soy responsable del cuidado y el Nombre de Propietario de la Casa
bienestar de ________________________________________________________ y los niño(s) Nombre(s) de los Padre(s) del Niño
______________________________________________________________que vive con migo Nombre(s) de los Niño(s)
en __________________________________________________________________________. Dirección de la Casa
Ciudad
Código Postal
NOTA: Debe traer cuenta de la luz (PG&E) con el mismo nombre como listó arriba de propietario de la casa y la dirección con esta forma
Declaro bajo pena de perjurio que la información anterior es verdadera y correcta a lo mejor de mi conocimiento. _________________________________
__________________________
Firma
Fecha Declaration Under Perjury 11/14
CENTRAL UNIFIED SCHOOL DISTRICT 4605 North Polk Avenue · Fresno, CA 93722 Phone: (559) 274-4700 · Fax: (559) 271-8200
BOARD OF TRUSTEES Richard Atkins Cynthia Berube Rubén Coronado Terry Cox Rama Dawar Cesar Granda Leonard G. Ramirez SUPERINTENDENT Mark G. Sutton
January 27, 2016
Dear Parent or Guardian: Re: New immunization requirements for 2016 Under a new law known as SB 277, beginning January 1, 2016, exemptions based on personal beliefs are no longer an option for the vaccines that are currently required for entry into child care or school in California. Most families will not be affected by the new law because their children have received all required vaccinations. Personal beliefs exemptions on file for a child already attending child care or school will remain valid until the child reaches the next immunization checkpoint at kindergarten (including transitional kindergarten) or 7th grade. For more information about SB 277, please see the Frequently Asked Questions available at: http://www.shotsforschool.org/laws/sb277faq/. For more information about school immunization requirements and resources, please visit the California Department of Public Health’s website at www.shotsforschool.org, or contact Fresno County Health Department Immunizations at (559) 600-3550. Thank you for helping us to keep our children and community healthy. Sincerely,
Brenda Vera RN, BSN, PHN Coordinator of Health Services Central Unified School District
District Administration Laurel Ashlock, Ed.D, Assistant Superintendent, Chief Academic Officer · Ketti Davis, Assistant Superintendent, Professional Development Jack Kelejian, Assistant Superintendent, Human Resources · Kelly Porterfield, Assistant Superintendent, Chief Business Officer Paul Birrell, Director, 7-12 and Adult Education · Tami Boatright Ed.D, Director, K-8 Education · Andrea Valadez, Administrator, Special Education & Support Services
CALIFORNIA IMMUNIZATION REQUIREMENTS FOR PRESCHOOL ENROLLMENT
Your child must have the immunizations listed below to attend Preschool A copy of your child’s Immunization Record must be provided along with your application as proof of immunization If your child has not received the Tuberculosis Skin Test (PPD) after August 1st of last year, then your child will need to have the test done and read prior to submitting your application
Vaccines
Required Dose(s) To Attend Preschool
Polio DTP/DPaP/DT/Td
3 doses – After age 4…if last one given before 2nd birthday, will need the 4th dose 4 doses – After age 4…if last one given before 2nd birthday, will need the 5th dose 1 dose – Must be given on or after the 1st birthday - **After age 4, will need 2nd dose 1 dose – Last dose must be given on or after the 1st birthday – If no dose given, one dose required until 4 ½ yrs. old 3 doses (3 dose series) 1 dose – Must be given on or after the 1st birthday or Health Care Provider must document if child has had chickenpox and shot will not be required 1 dose – Must be given within one year of entry into school (after August 1st of last year & before August of this year
MMR (Measles, Mumps, Rubella) Hib Meningitis Hepatitis B Varicella Tuberculosis Skin Test (PPD)
If your child needs any of the required immunizations and you do not have private insurance, you may contact Fresno County Department of Health 1221 Fulton Mall - First Floor Phone: 600-3550
General Information Parent or legal guardian must be present Bring your child’s immunization card or shot record Bring Medi-Cal Card Immunizations will be given on a first-come, first served basis Walk Ins - Monday and Wednesday from 8:00 am to 11:00am and 1:00 pm to 3:00 pm (Closed 12:00 to 1:00 for lunch)
Cost Medi-Cal – Free $17.55 Per Shot $8.08 Per TB Skin Test
FOR TB SKIN TESTS (PPD) ONLY
You may call the School Nurse at any school site listed below to schedule an appointment
School Sites Liddell Elementary School El Capitan Middle School Rio Vista Middle School Central East High School
Phone Numbers 276-3176 276-5270 276-3185 276-0280, Extension 50133
Imm Req 12/15
● Turn four (4) years of age between December 3, 2015 & December 2, 2016 of the school year from July 1, 2016 to June 30, 2017 Your child’s birthdate must be between December 3, 2011 and December 2, 2012 ● Be toilet trained and be able to use the restroom independently ● Have a TB test & reading given after August 1, 2015 and be current with all immunizations ● Have a physical examination given after August 1, 2015 AND THE FAMILY MUST
● Live in Central Unified School District ● The applicant must be the adult who is responsible in providing the care & welfare for the preschooler ● Qualify by the State Guideline as listed in the table below - If over income, you will be denied ● Provide own transportation to and from school - No bus is available STATE INCOME GUIDELINES Effective 1-1-09-CDE – Management Bulletin 08-17 (Subject to Change)
Your family income must be at or below the state guideline listed below to qualify # of Persons in Family
1-2 3 4
Gross Monthly Income Family Yearly Income
$3,283.00 $3,518.00 $3,908.00
$39,396.00 $42,216.00 $46,896.00
# of Persons in Family Gross Monthly Income Family Yearly Income
5 6 7
$4,534.00 $5,159.00 $5,276.00
$54,408.00 $61,908.00 $63,312.00
PLACEMENT GUIDELINES
Placement into a class is based on your eligibility ranking, according to income and family size, established by the State of California;
Placement is NOT on a first come, first served basis First priority is given to Protective Service Children and At-Risk Children Second priority is given to those children whose birthdays are between December 2 and September 1 Priority of your child’s enrollment can change at any time depending on your eligibility and the eligibility of other families Applications received during Early Bird Registration (March 15, 2016 – April 29, 2016) will be given priority over applications received after April 29th. If your application is accepted and an opening is available, you will be contacted by phone or email to schedule an appointment to complete the Registration and Enrollment Paperwork If your application is not accepted after review, you w (1)byCOPY l beONE notified mail OF THE FOLLOWING DOCUMENTS MUST BE SUBMITTED WITH YOUR APPLICATION
Birth Certificates of ALL children (under 18) living in the home Proof of Address from Parent(s) Living With The Child – A copy of the most recent Utility Bill or Rental/Lease Agreement with prior month
receipt of payment to show that you are the responsible party in the care & welfare needs of the preschool child & siblings o If the above documents are not in your name, but you live with someone who owns the house and the utilities are in their name; the homeowner must complete and sign the attached Self-Declaration Under Penalty of Perjury form stating they are not responsible for the care & welfare needs of preschooler’s family and the Homeowner must provide a copy of their recent Utility Bill or Rental/Lease Agreement with prior month receipt of payment Preschool Child’s Immunization Record – Immunizations must be current along with a TB skin test & reading given after August 1st of last year Physical Examination – Must have been given after August 1st of last year. Have your child’s doctor provide you with a copy of the physical report or have the doctor complete the attached Physician’s Report form FOR CHILDREN LIVING WITH A GUARDIAN OR FOSTER PARENTS ONLY: Caregiver Affidavit – If child’s caretaker is a Foster Child and/or Guardianship Foster Parent’s Agreement (SOC 156) and/or court order “Appointing guardian of Minor & Certified Home Agreement” must be submitted and processed in the Student Support Services Department at Central Unified School District Office, 5652 W. Gettysburg Ave, Room 13. Please call 274-4700 ext. 63138, for any questions regarding the Caregiver Affidavit PRESCHOOL OFFICE ♦ 5652 W. Gettysburg, Room 10, Fresno, CA 93722 ♦ Phone (559) 274-4700 Ext 63199 ♦ Fax (559) 277-4527 1/16
Declaration Under Penalty of Perjury
(Declaration of Residency)
I _______________________________________am not responsible for the care and welfare Name of Owner of Home
for ______________________________________ and her/his child(ren) __________________ Name(s) of Preschooler’s Parent(s)
List Name(s) of Child(ren)
______________________________________________________________who live with me at _____________________________________________________________________________. Street Address
City
Zip Code
NOTE: Must bring current PG&E bill with the same name as listed above of owner of home and address with this form.
I declare under penalty of perjury that the above information is true and correct to the best of my knowledge. _________________________________
__________________________
Signature
Date
Declaración Bajo Pena de Perjurio (Declaración de Residencia)
Yo _______________________________________no soy responsable del cuidado y el Nombre de Propietario de la Casa
bienestar de ________________________________________________________ y los niño(s) Nombre(s) de los Padre(s) del Niño
______________________________________________________________que vive con migo Nombre(s) de los Niño(s)
en __________________________________________________________________________. Dirección de la Casa
Ciudad
Código Postal
NOTA: Debe traer cuenta de la luz (PG&E) con el mismo nombre como listó arriba de propietario de la casa y la dirección con esta forma
Declaro bajo pena de perjurio que la información anterior es verdadera y correcta a lo mejor de mi conocimiento. _________________________________
__________________________
Firma
Fecha Declaration Under Perjury 11/14
CENTRAL UNIFIED SCHOOL DISTRICT 4605 North Polk Avenue · Fresno, CA 93722 Phone: (559) 274-4700 · Fax: (559) 271-8200
BOARD OF TRUSTEES Richard Atkins Cynthia Berube Rubén Coronado Terry Cox Rama Dawar Cesar Granda Leonard G. Ramirez SUPERINTENDENT Mark G. Sutton
January 27, 2016
Dear Parent or Guardian: Re: New immunization requirements for 2016 Under a new law known as SB 277, beginning January 1, 2016, exemptions based on personal beliefs are no longer an option for the vaccines that are currently required for entry into child care or school in California. Most families will not be affected by the new law because their children have received all required vaccinations. Personal beliefs exemptions on file for a child already attending child care or school will remain valid until the child reaches the next immunization checkpoint at kindergarten (including transitional kindergarten) or 7th grade. For more information about SB 277, please see the Frequently Asked Questions available at: http://www.shotsforschool.org/laws/sb277faq/. For more information about school immunization requirements and resources, please visit the California Department of Public Health’s website at www.shotsforschool.org, or contact Fresno County Health Department Immunizations at (559) 600-3550. Thank you for helping us to keep our children and community healthy. Sincerely,
Brenda Vera RN, BSN, PHN Coordinator of Health Services Central Unified School District
District Administration Laurel Ashlock, Ed.D, Assistant Superintendent, Chief Academic Officer · Ketti Davis, Assistant Superintendent, Professional Development Jack Kelejian, Assistant Superintendent, Human Resources · Kelly Porterfield, Assistant Superintendent, Chief Business Officer Paul Birrell, Director, 7-12 and Adult Education · Tami Boatright Ed.D, Director, K-8 Education · Andrea Valadez, Administrator, Special Education & Support Services
CALIFORNIA IMMUNIZATION REQUIREMENTS FOR PRESCHOOL ENROLLMENT
Your child must have the immunizations listed below to attend Preschool A copy of your child’s Immunization Record must be provided along with your application as proof of immunization If your child has not received the Tuberculosis Skin Test (PPD) after August 1st of last year, then your child will need to have the test done and read prior to submitting your application
Vaccines
Required Dose(s) To Attend Preschool
Polio DTP/DPaP/DT/Td
3 doses – After age 4…if last one given before 2nd birthday, will need the 4th dose 4 doses – After age 4…if last one given before 2nd birthday, will need the 5th dose 1 dose – Must be given on or after the 1st birthday - **After age 4, will need 2nd dose 1 dose – Last dose must be given on or after the 1st birthday – If no dose given, one dose required until 4 ½ yrs. old 3 doses (3 dose series) 1 dose – Must be given on or after the 1st birthday or Health Care Provider must document if child has had chickenpox and shot will not be required 1 dose – Must be given within one year of entry into school (after August 1st of last year & before August of this year
MMR (Measles, Mumps, Rubella) Hib Meningitis Hepatitis B Varicella Tuberculosis Skin Test (PPD)
If your child needs any of the required immunizations and you do not have private insurance, you may contact Fresno County Department of Health 1221 Fulton Mall - First Floor Phone: 600-3550
General Information Parent or legal guardian must be present Bring your child’s immunization card or shot record Bring Medi-Cal Card Immunizations will be given on a first-come, first served basis Walk Ins - Monday and Wednesday from 8:00 am to 11:00am and 1:00 pm to 3:00 pm (Closed 12:00 to 1:00 for lunch)
Cost Medi-Cal – Free $17.55 Per Shot $8.08 Per TB Skin Test
FOR TB SKIN TESTS (PPD) ONLY
You may call the School Nurse at any school site listed below to schedule an appointment
School Sites Liddell Elementary School El Capitan Middle School Rio Vista Middle School Central East High School
Phone Numbers 276-3176 276-5270 276-3185 276-0280, Extension 50133
Imm Req 12/15
