Enrollment Form amazonaws com
Goddard School District, USD 265 201 S. Main • PO Box 249 • Goddard, Kansas 67052 office: (316) 794-4000 • fax: (316) 794-2222 • Web Site: www.goddardusd.com
Student Enrollment Form Grade (2015-16):
Sex (circle): F / M
Birthdate:
Social Security #:
Legal Name (Last, First, Middle):
Nickname:
Home Address (Street Address, City, State, Zip): Subdivision: Mailing Address (if different than home address): Home Phone: ( ) Former School: Race & Ethnicity: Is this student Hispanic/Latino? Choose only one: NO
YES
(not Hispanic/Latino)
(A person of Cuban, Mexican, Puerto
Rican, South or Central American, or other Spanish culture or origin, regardless of race.)
Please continue to answer the following by marking 1 or more boxes to indicate what you consider your student’s race to be.
What is the student’s race? Choose one or more:
American Indian or Alaska Naive (A person having origins in any of the original peoples of No. & So.
American (including Central America), & who maintains tribal affiliations or community attachment.)
Asian (A person having origins in any of the original peoples of the Far East,
SE Asia, or the Indian subcontinent including, for example Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, & Vietnam.) African American (A person having origins in any of the black racial groups of Africa.) peoples of Hawaii, Guam, Samoa, or other Pacific Islands.)
Black or
Native Hawaiian or Other Pacific Islander (A person having origins in any of the original
White (A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.)
Parent/Guardian Information Student lives with:
Both Parents
Mom & Stepfather
Dad & Stepmother
Mom only
Parent/Guardian 1: Last Name
First Name
Mailing Address
Dad only
Parent/Guardian 2: Relationship
City
State
Last Name Zip
First Name
Mailing Address
Relationship
City
State
Employer
Work Phone, Ext.
Employer
Work Phone, Ext.
Cell/Mobile Phone
E-mail Address
Cell/Mobile Phone
E-mail Address
Zip
Student mailings automatically go to the student’s mailing address above. If additional mailings are needed, please provide the following information: Last name
First Name
Relationship
Street Address
City
State
Zip
Emergency Information Emergency Contact: (Please list someone other than parent/guardian for contact in case of illness or emergency)
Family Doctor’s Name:
Relationship
Phone
Phone
NOTE: ANNUAL HEALTH UPDATE FORM MUST BE COMPLETED FOR EACH STUDENT.
Please complete all that apply below: 1.
If natural parents are divorced, residential custody of child is with: (Please provide a copy of the most recent court order)
2.
Has student been enrolled in special education classes? YES / NO -- please explain:
3.
Does student have limited use of English language? NO YES -- Language spoken at home if other than English:
This student is not currently under an expulsion decree from any other school. YES NO If the answer is yes, identify the reason for the expulsion. If any part of this statement is found to be false, the student will be disenrolled from school immediately. I, the undersigned, hereby swear or affirm that the above-named pupil is a resident of USD 265, resides at the address so stated, and that all information supplied is true and accurate to the best of my knowledge. I have a legal right to make all decisions in connection with the health and welfare of such pupil and am responsible for the above-named pupil regarding all school matters.
Parent/Guardian Signature
Date
If necessary, please attach additional information to this form. Thank you! GD-11A Student Enrollment Form (revised 3-15)
Enrollment Policy Identification of Students All students enrolling in the district for the first time shall provide required proof of identity. Students enrolling in kindergarten or first grade shall provide a certified copy of their birth certificate. Students enrolling in grades 2-12 shall provide a certified transcript or similar pupil records. Other documentation, which the board determines to be satisfactory, may be provided. Resident Students A resident student is any child who has attained the age of eligibility for school attendance and lives with a parent or a person acting as a parent that is a resident of the district. Homeless children located in the district will be admitted as resident students. For purposes of this policy, parent means the natural parents, adoptive parents, step-parents and foster parents. For purposes of this policy, person acting as a parent means a guardian or conservator, a person liable by law to care for and support the child, a person who has actual care and control of the child and provides a major portion of support or a person who has actual care and control of the child with written consent of a person who has legal custody of the child. Enrollment in specific classes by resident students attending private/home school programs may be allowed, with permission of the Superintendent of Schools, prior to September 20 provided that staff, equipment and supplies are available. The parent/guardian of a private/home school student must provide evidence of registration of their school with the Kansas State Department of Education at the time of application. Transportation will be the responsibility of the resident seeking enrollment. Students in grades 7-12 will be unable to participate in interscholastic competition, unless they meet all requirements of the Kansas State High School Activities Association. Non-resident Students Non-resident students with no previous history of district residency are not accepted in the district. Students who have moved their primary residence from the district, but who have continued to enroll and attend Goddard Schools on an uninterrupted basis will be allowed to continue to enroll if they meet the requirements set forth in the BOE Policy JBC. Section 504: Student and Parent Rights in Identification, Evaluation and Placement The following is a description of student and parent rights granted by federal law. The intent of the law is to keep you fully informed concerning decisions about your child and to inform you of your rights if you disagree with any of these decisions. You have the right to: 1. Have your child take part in, and receive benefits from public education programs without discrimination based on a disability. 2. Have the school district advise you as to your rights under federal law. 3. Receive notice with respect to identification, evaluation, or placement of your child. 4. Have your child receive a free, appropriate public education. This includes the right to be educated with other students to the maximum extent appropriate. It also includes the right to have the school district make reasonable accommodations to allow your child an equal opportunity to participate in school and schoolrelated activities. 5. Have your child educated in facilities and receive services comparable to those provided students without disabilities. 6. Have your child receive special education and related services if she/he is found to be eligible under the Individuals with Disabilities Education Act (IDEA) (PL 101-476), or to receive reasonable accommodations under Section 504 of the Rehabilitation Act. 7. Have evaluation, educational, and placement decisions made based upon a variety of information sources, and by individuals who know the student, the evaluation data, and placement options. 8. Have transportation provided to a school placement setting at no greater cost to you than would be incurred if the student were placed in a program operated by the school district. 9. Give your child an equal opportunity to participate in nonacademic and extracurricular activities offered by the school district. 10. Examine all relevant records relating to decisions regarding your child’s identification, evaluation, educational program, and placement. 11. Obtain copies of educational records at a reasonable cost if the fee would effectively deny you access to the records. 12. Receive a response from the school district to reasonable requests for explanations and interpretations of your child’s records. 13. Request amendment of your child’s education records if there is reasonable cause to believe that they are inaccurate, misleading or otherwise in violation of the privacy rights of your child. If the school district refuses this request, it shall notify you within a reasonable time, and advise you of the right to a hearing. 14. Request mediation or an impartial due process hearing related to decisions regarding your child’s identification, evaluation, educational program, or placement. You and your child may take part in the hearing and have an attorney represent you. 15. Ask for payment of reasonable attorney fees if you are successful on your claim. 16. File a local grievance. (The person in the Goddard School District who is responsible for Section 504 compliance is the Assistant Superintendent for Human Resources.)
The Goddard Public Schools do not discriminate on the grounds of race, color, religion, sex, age, or disability in admission or access to, or treatment or employment in its programs or activities. Inquiries should be directed to the USD 265 Assistant Superintendent. Individuals with disabilities who require assistance or special arrangements to participate in a program or activity sponsored by a Goddard Public School should contact the principal of the school. We request that you provide 48-hour notice so proper arrangements may be made.
GD-11A Student Enrollment Form (revised 3-15)
Student Enrollment Form Grade (2015-16):
Sex (circle): F / M
Birthdate:
Social Security #:
Legal Name (Last, First, Middle):
Nickname:
Home Address (Street Address, City, State, Zip): Subdivision: Mailing Address (if different than home address): Home Phone: ( ) Former School: Race & Ethnicity: Is this student Hispanic/Latino? Choose only one: NO
YES
(not Hispanic/Latino)
(A person of Cuban, Mexican, Puerto
Rican, South or Central American, or other Spanish culture or origin, regardless of race.)
Please continue to answer the following by marking 1 or more boxes to indicate what you consider your student’s race to be.
What is the student’s race? Choose one or more:
American Indian or Alaska Naive (A person having origins in any of the original peoples of No. & So.
American (including Central America), & who maintains tribal affiliations or community attachment.)
Asian (A person having origins in any of the original peoples of the Far East,
SE Asia, or the Indian subcontinent including, for example Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, & Vietnam.) African American (A person having origins in any of the black racial groups of Africa.) peoples of Hawaii, Guam, Samoa, or other Pacific Islands.)
Black or
Native Hawaiian or Other Pacific Islander (A person having origins in any of the original
White (A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.)
Parent/Guardian Information Student lives with:
Both Parents
Mom & Stepfather
Dad & Stepmother
Mom only
Parent/Guardian 1: Last Name
First Name
Mailing Address
Dad only
Parent/Guardian 2: Relationship
City
State
Last Name Zip
First Name
Mailing Address
Relationship
City
State
Employer
Work Phone, Ext.
Employer
Work Phone, Ext.
Cell/Mobile Phone
E-mail Address
Cell/Mobile Phone
E-mail Address
Zip
Student mailings automatically go to the student’s mailing address above. If additional mailings are needed, please provide the following information: Last name
First Name
Relationship
Street Address
City
State
Zip
Emergency Information Emergency Contact: (Please list someone other than parent/guardian for contact in case of illness or emergency)
Family Doctor’s Name:
Relationship
Phone
Phone
NOTE: ANNUAL HEALTH UPDATE FORM MUST BE COMPLETED FOR EACH STUDENT.
Please complete all that apply below: 1.
If natural parents are divorced, residential custody of child is with: (Please provide a copy of the most recent court order)
2.
Has student been enrolled in special education classes? YES / NO -- please explain:
3.
Does student have limited use of English language? NO YES -- Language spoken at home if other than English:
This student is not currently under an expulsion decree from any other school. YES NO If the answer is yes, identify the reason for the expulsion. If any part of this statement is found to be false, the student will be disenrolled from school immediately. I, the undersigned, hereby swear or affirm that the above-named pupil is a resident of USD 265, resides at the address so stated, and that all information supplied is true and accurate to the best of my knowledge. I have a legal right to make all decisions in connection with the health and welfare of such pupil and am responsible for the above-named pupil regarding all school matters.
Parent/Guardian Signature
Date
If necessary, please attach additional information to this form. Thank you! GD-11A Student Enrollment Form (revised 3-15)
Enrollment Policy Identification of Students All students enrolling in the district for the first time shall provide required proof of identity. Students enrolling in kindergarten or first grade shall provide a certified copy of their birth certificate. Students enrolling in grades 2-12 shall provide a certified transcript or similar pupil records. Other documentation, which the board determines to be satisfactory, may be provided. Resident Students A resident student is any child who has attained the age of eligibility for school attendance and lives with a parent or a person acting as a parent that is a resident of the district. Homeless children located in the district will be admitted as resident students. For purposes of this policy, parent means the natural parents, adoptive parents, step-parents and foster parents. For purposes of this policy, person acting as a parent means a guardian or conservator, a person liable by law to care for and support the child, a person who has actual care and control of the child and provides a major portion of support or a person who has actual care and control of the child with written consent of a person who has legal custody of the child. Enrollment in specific classes by resident students attending private/home school programs may be allowed, with permission of the Superintendent of Schools, prior to September 20 provided that staff, equipment and supplies are available. The parent/guardian of a private/home school student must provide evidence of registration of their school with the Kansas State Department of Education at the time of application. Transportation will be the responsibility of the resident seeking enrollment. Students in grades 7-12 will be unable to participate in interscholastic competition, unless they meet all requirements of the Kansas State High School Activities Association. Non-resident Students Non-resident students with no previous history of district residency are not accepted in the district. Students who have moved their primary residence from the district, but who have continued to enroll and attend Goddard Schools on an uninterrupted basis will be allowed to continue to enroll if they meet the requirements set forth in the BOE Policy JBC. Section 504: Student and Parent Rights in Identification, Evaluation and Placement The following is a description of student and parent rights granted by federal law. The intent of the law is to keep you fully informed concerning decisions about your child and to inform you of your rights if you disagree with any of these decisions. You have the right to: 1. Have your child take part in, and receive benefits from public education programs without discrimination based on a disability. 2. Have the school district advise you as to your rights under federal law. 3. Receive notice with respect to identification, evaluation, or placement of your child. 4. Have your child receive a free, appropriate public education. This includes the right to be educated with other students to the maximum extent appropriate. It also includes the right to have the school district make reasonable accommodations to allow your child an equal opportunity to participate in school and schoolrelated activities. 5. Have your child educated in facilities and receive services comparable to those provided students without disabilities. 6. Have your child receive special education and related services if she/he is found to be eligible under the Individuals with Disabilities Education Act (IDEA) (PL 101-476), or to receive reasonable accommodations under Section 504 of the Rehabilitation Act. 7. Have evaluation, educational, and placement decisions made based upon a variety of information sources, and by individuals who know the student, the evaluation data, and placement options. 8. Have transportation provided to a school placement setting at no greater cost to you than would be incurred if the student were placed in a program operated by the school district. 9. Give your child an equal opportunity to participate in nonacademic and extracurricular activities offered by the school district. 10. Examine all relevant records relating to decisions regarding your child’s identification, evaluation, educational program, and placement. 11. Obtain copies of educational records at a reasonable cost if the fee would effectively deny you access to the records. 12. Receive a response from the school district to reasonable requests for explanations and interpretations of your child’s records. 13. Request amendment of your child’s education records if there is reasonable cause to believe that they are inaccurate, misleading or otherwise in violation of the privacy rights of your child. If the school district refuses this request, it shall notify you within a reasonable time, and advise you of the right to a hearing. 14. Request mediation or an impartial due process hearing related to decisions regarding your child’s identification, evaluation, educational program, or placement. You and your child may take part in the hearing and have an attorney represent you. 15. Ask for payment of reasonable attorney fees if you are successful on your claim. 16. File a local grievance. (The person in the Goddard School District who is responsible for Section 504 compliance is the Assistant Superintendent for Human Resources.)
The Goddard Public Schools do not discriminate on the grounds of race, color, religion, sex, age, or disability in admission or access to, or treatment or employment in its programs or activities. Inquiries should be directed to the USD 265 Assistant Superintendent. Individuals with disabilities who require assistance or special arrangements to participate in a program or activity sponsored by a Goddard Public School should contact the principal of the school. We request that you provide 48-hour notice so proper arrangements may be made.
GD-11A Student Enrollment Form (revised 3-15)
