Central Community School System

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1 Central Community School System INFORMATION FOR PARENT/GUARDIAN REGARDING CENTRALIZED REGISTRATION Centralized Registration is held at the Central Community School Board Office located at Joor Road, Suite 300, Baton Rouge, LA Registration for the school year will begin Monday, June 17, Please note registration days and hours. Additional information and registration forms can be found on our website at Registration days and hours are as follows: Monday and Wednesday 8:00 a.m. 11:00 a.m. * You must arrive and be signed in by 10:45 a.m. Tuesday and Thursday 1:00 p.m. 4:00 p.m. *You must arrive and be signed in by 3:30 p.m. New student documents required for registration: 1. Birth certificate 2. Social security card 3. Immunization records 4. Last report card 5. Withdrawal slip from previous school attended 6. Copy of test results from state testing (grades 3-8) 7. Transcripts (if student is in high school) 8. Current custody papers (signed by a judge) showing domiciliary parent if parents are divorced NOTE: Provisional Custody by Mandate will not be accepted. Residency documents required for registration. All documents must have the same address in the Central Community School System: IF CHILD S DOMICILE IS OWNED BY PARENT IF CHILD S DOMICILE IS LEASED BY PARENT Certified copy of documents recorded with the East Copy of the lease of the residence for the school year. Baton Rouge Parish clerk of Court showing ownership If lease expires prior to end of school year, additional of domicile. documentation of domicile will be required upon OR expiration. Property tax bill or homestead exemption for the most recent tax year for the domicile Previous two months bills for the electricity bill and previous two months of one of the following utilities (gas, water or garbage) for the domicile. Disconnect Notices will not be accepted. Domiciliary parent s: Current driver s license with the same address within the Central Community School System. *Affidavit of Residency Form if domicile is not owned by parent. Residency requirements of home owner must be provided. Parent will be required to present updated current information prior to the start of each school year in order for their children to be enrolled for the next school year. Previous two months bills for the electricity bill and previous two months of one of the following utilities (gas, water or garbage) for the domicile if it is not provided for in the lease agreement. Disconnect Notices will not be accepted. Domiciliary parent s: Current driver s license with the same address within the Central Community School System. *Affidavit of Residency Form if domicile is not leased by parent. Residency requirements of leased property must be provided. REVISED 9/14/15

2 Central Community School System REGISTRATION DOCUMENT CHECKLIST New Student and Currently Reside in CCSS District Status Update (ie Re-register, Change of Address Name Change, Guardianship) student documents STUDENTS ENTERING: 1 Birth Certificate 2 Social Security Card 3 Immunization Records 4 Last Report Card Pre-K or K: Documents st - 3 rd : Documents th - 9 th : Documents th - 12 th: Document 1-7 **Custody Papers are Needed for all students if applicable.** Required Residency Documents are noted below. Student Name(s) and Grade: 5 Withdrawal Slip from previous school attended 6 Copy of test results from State testing (grades 3-8) 7 Transcripts (if student is in high school) 8 Current custody papers signed by a JUDGE showing domiciliary parent if parents are divorced. NOTE: Provisional Custody by Mandate is not accepted. residency documents: IF THE PARENT IS THE HOMEOWNER OR LESEE: 1 Ownership of Home (i.e. Cash Sale) OR Homestead Exemption OR Property Tax Bill OR Lease (Term must be during current school year) 2 Drivers License of Parent (address must match residence address) 3 Electricity Bills (Previous 2 month bills) DISCONNECT NOTICES NOT ACCEPTED 4 Gas or Water Bills (Previous 2 month bills) DISCONNECT NOTICES NOT ACCEPTED IF THE PARENT RESIDES WITH SOMEONE (DOUBLE UP): 1 Drivers License of Parent (address must match residence address) AND the following Documentation of the Homeowner/Lessee as follows: 2 Ownership of Home (i.e. Cash Sale) OR Homestead Exemption OR Property Tax Bill OR Lease (Term must be during current school year) 3 Copy of Drivers License of Homeowner/Lessee (address must match residence address) 4 Electricity Bills (Previous 2 month bills) DISCONNECT NOTICES NOT ACCEPTED 5 Gas or Water Bills (Previous 2 month bills) DISCONNECT NOTICES NOT ACCEPTED 6 Notarized Affidavit of Residency NOTE: Affidavit of Residency may be required in other circumstances as directed by CCSS.

3 STUDENT INFORMATION GRADE ENTERING Central Community School System Student Registration and Data Verification Form Re-register Status Change PARENTS: This is your child s registration form. Please complete ALL blank items in each section. Student s LEGAL Last Name First Name Middle Name Date of Birth Social Security # Birth Certificate # Student s Address Apt. Zip Code Primary Ethnic: (Choose One) Secondary Ethnic: (Choose One) New Student Has the student ever attended a school in Louisiana? Y / N Last school attended? Date of Entry into the United States (If not born in the U.S.) Male Female Foster Placement (FOS Program) Language spoken at home Language first acquired by student Language most often spoken by student SCHOOL YEAR Address Change Name Change Guardianship Migrant 0 White 1 Black or African American 2 Hispanic 3 Asian 4 Native American/ 5 Hawaiian/ Alaskan Native Pacific Islander 0 White 1 Black or African American 2 Hispanic 3 Asian 4 Native American/ 5 Hawaiian/ Alaskan Native Pacific Islander Has the student ever attended a school in Central? Y / N If school is not in Central, please list Address: Address: City State Zip: Has this student ever received services as a Special Education student? Y / N Does your child have an IEP? Y / N If yes, please indicate the student s exceptionality: Speech Gifted Talented Other Has this student ever received 504 services? Y / N Where did the student attend Pre-K? Brothers/Sisters in a Central School This Year Date of Birth School Grade PARENT / GUARDIAN INFORMATION Are parents divorced? Yes No If divorced, name of parent deemed the domiciliary parent by a judge? Is Parent/Guardian s residence: Owned Leased Resides with someone who lives in CCSS District Relation Last Name First Name Does the student reside at this address? Y / N Street Address Apt. City Zip Home Phone Cell Phone Other Phone Place of Employment Work Phone Relation Last Name First Name Does the student reside at this address? Y / N Street Address Apt. City Zip Home Phone Cell Phone Other Phone Place of Employment Work Phone *Court papers (signed by a judge) MUST be provided at the time of registration indicating which parent is the Domiciliary Parent OR who is the Legal Guardian of the child(ren). Active /Reserve/Retired Military/National Guard? Yes No Active /Reserve/Retired Military/National Guard? Yes No GENERAL INFORMATION Person authorized to pick up your child Home Phone Other Phone Person authorized to pick up your child Home Phone Other Phone Emergency Contact Home Phone Other Phone Emergency Contact Home Phone Other Phone After school, how does the student get home or to after school care? Student s Doctor/Clinic Doctor/Clinic Phone Hospital of Choice Special medical conditions/allergies/procedures of which the school should be aware: ALL OF THE ABOVE INFORMATION IS CORRECT. PARENT/GUARDIAN SIGNATURE DATE Rev 5/10/18

4 PHONE: FAX: CENTRAL COMMUNITY SCHOOL SYSTEM Bus Stop Request Form SCHOOL YEAR 2019/2020 New Student and Currently Reside in CCSS District Status Change Re-register Change of Address Other REQUEST MUST BE SIGNED BY STUDENT SERVICES OR SCHOOL ADMINISTRATION BEFORE A BUS NUMBER IS ASSIGNED. PLEASE NOTE: A MAXIMUM OF THREE DAYS COULD BE REQUIRED TO EFFECTIVELY INSTITUTE THE REQUESTED CHANGE. CHILDREN IN PREK-4 TH GRADE MUST HAVE SOMEONE VISIBLE IN ORDER TO BE RELEASED FROM THE BUS. Student Name: Parent/Guardian s Name: (please print) Date: DO ( ) DO NOT ( ) WANT BUS SERVICE FOR MY CHILD. Parent/Guardian s Signature: If requesting bus service, please complete the following information for your child. Student Grade: School Attending: Primary Phone # of Parent/Guardian: Secondary Phone # of Parent/Guardian Student s Current Address: Complete Physical Address of Requested Bus Stop in the MORNING Street Name/Number City Zip Date Stop to Begin: Complete Physical Address of Requested Bus Stop in the AFTERNOON Date Stop to Begin: Complete Physical Address of Requested Bus Stop for ADDITIONAL Bus Stop: AM PM Date Stop to Begin: If your child receives Special Education Services, does your child s I.E.P. indicate special transportation services be provided? Emergency Contact and Phone Numbers: School Administrator Signature: Yes No TO BE FILLED OUT BY FIRST STUDENT OFFICE ONLY Bus # Stop Location P/U Time Bus # Stop Location D/O Time REV. 5/10/18

5 LOUISIANA STUDENT RESIDENCY QUESTIONNAIRE (Form Must Be Included In School Enrollment Packet) Date District School Name Student Name: SSN/ID#: Gender: Male / Female Address: Telephone Number: Last School Attended: Current Grade: Date of Birth: Parent / Guardian / Adult caring for Student: Relationship: Disclaimer: This questionnaire is intended to address the McKinney-Vento Act. Your child may be eligible for additional educational services through Title I Part A, Title I Part C- Migrant, Individuals with Disabilities Education Act (IDEA) and/or Title IX, Part A, Federal McKinney-Vento Assistance Act, 42 U.S.C Eligibility can be determined by completing this questionnaire. It is illegal to knowingly make false statements on this form. If eligible, students are to be immediately enrolled in accordance with Bulletin 741, section YES NO Is the student s address a temporary living arrangement? (Note: If this is a permanent living arrangement or the family owns or rents their home, sign under item 9 and submit form to school personnel.) 2. YES NO Is the temporary living arrangement due to loss of housing or economic hardship? 3. YES NO Does the student have a disability or receive any special education-related services? (Check one) 4. Where is the student currently living? (Check all that apply.) In an emergency/transitional shelter. Temporarily with another family because we cannot afford or find affordable housing. With an adult that is not a parent or legal guardian, or alone without an adult. In a vehicle of any kind, trailer park or campground without running water/electricity, abandoned building or substandard housing. Emergency Housing (i.e. FEMA Trailer or FEMA Rental Assistance) In a hotel/motel. Other specific information: 5. YES NO Does the student exhibit any behaviors that may interfere with his or her academic performance? 6. Would you like assistance with uniforms, student records, school supplies, transportation, other? (Describe: ) 7. YES NO Migrant Have you moved at time during the past three (3) years to seek temporary or seasonal work in agriculture (including Poultry processing, dairy, nursery, and timber) or fishing? 8. YES NO Does the student have siblings (brothers or sisters)? Note: Use back of page if more space is needed. Name School Grade DOB Name School Grade DOB Name School Grade DOB 9. The undersigned certifies that the information provided above is accurate. Print Parent/Guardian/Adult Caring for Student s Name Signature Date (Area Code) Phone Number Street Address City State Zip Code School Use Only: Free or Reduced Price Meals Form submitted/signed Copy Placed in Student s Cumulative Record Homeless Liaison Use Only Check All that Apply: Sheltered Doubled-Up Unsheltered/FEMA Hotel/Motel Unaccompanied Youth: YES NO Print School Contact Name Title Signature Date 06/2017

6 [LEA Letterhead] TITLE VII, SUBPART B MCKINNEY-VENTO Homeless Assistance Act, as Reauthorized by TITLE IX, PART A OF ESSA CONFIDENTAL REFERRAL FORM Louisiana School District Date Date Not In School Student Name School Parent/Guardian SS# or USID IEP: Yes No Gender ( M / F ) Race DOB Age Grade Phone Number Temporary Address City Zip Referring Person Position Reason for referral: Problems listed below often prevent homeless children and youths from attending school. Please check all areas of concern which apply to the student identified above. School of origin: Yes No Student lacks a permanent residence Student is unable to pay school fees Immunizations are needed Birth certificate is needed Excessive absences are a problem Lacks academic records and/or documentation Academic problems indicate a need for tutoring School supplies are needed Transportation to school is a problem Student/family needs assistance accessing community resources Behavior indicates a need for mental health counseling School clothes are needed (Sizes: Shirt Pants Shoes Other ) Free lunch form needed Health problems are indicated Need Health Insurance (LA CHIP/Medical Card) Guardianship is a problem IDEA (gifted, talented, disabilities) services needed LEP/ESL services needed Migrant services needed Need SNAP benefits (food stamps) Check all that apply: (1) Sheltered (2) Doubled-Up (3) Unsheltered/FEMA (4) Hotel/Motel Unaccompanied Youth: Yes No 01 Mortgage Foreclosure 02 - Flooding 03 - Hurricane 04 - Tropical Storm 05 - Tornado 06 - Wildfire or Fire 07 Man-made Disaster (Major) 99 Other: ( i.e., lack of affordable housing, longterm poverty, unemployment or under-employment, lack of affordable health care, mental illness, domestic violence, forced eviction, etc.) COMMENTS: Other Children in Home: School Personnel Signature Date Homeless Liaison Signature Date *LIAISON S SIGNATURE INDICATES STUDENT(S) MEETS TITLE IX, PART A REQUIREMENTS Copy Sent to District Homeless Liaison Copy Placed in Student s Cumulative Record (Revised 06/2017)

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