Please fill out form, print and bring with you to register at the selected campus. BOERNE INDEPENDENT SCHOOL DISTRICT STUDENT ENROLLMENT FORM

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1 Please fill out form, print and bring with you to register at the selected campus. BOERNE INDEPENDENT SCHOOL DISTRICT STUDENT ENROLLMENT FORM Student Name: Last First Middle Suffix Grade: Gender: Birth : Place of Birth: Social Security Number: Mailing Address: City: Zip: (Physical Address- if different) Parent/ Guardian Information Parent/Guardian #1: Relationship to Student: of Birth Address: City: Zip: address: Employer: Note: Parent #1 receives all student-related communications. Parent/Guardian #2: Relationship to Student: of Birth Address: City: Zip: address: Employer: Student lives with: Parent/Guardian #1 Is either parent/guardian: Active Active Texas National Guard Active US Military Reserve Force Emergency Contacts other than parent/guardian Emergency Contact #1: Relationship to Student: Emergency Contact #2: Relationship to Student: Medical Information and Allergies Medical: Medications: Doctor s Name: Phone: Preferred Hospital: Food: Medicines: Insects: Other: Allergy Reaction Signature of Parent/Guardian Office Use Only: Student ID Teacher Entry POR SSC BC DL IMM G/WD Page 1

2 Texas Education Agency Texas Public School Student /Staff Ethnicity and Race Data questionnaire The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff. This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC). School district staff and parents or guardians of students enrolling in school are requested to provide this information. If you decline to provide this information, please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting. Please answer both parts of the following questions on the student s or staff member s ethnicity and race. United States Federal Register (71 FR 44866) Part 1. Ethnicity: Is the person Hispanic/Latino? (Choose only one) Hispanic/Latino A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. Not Hispanic/Latino Part 2. Race: What is the person s race? (Choose one or more) American Indian or Alaska Native A person having origins in any of the original peoples or North and South America (including Central America) and who maintains a tribal affiliation or community attachment. Asian a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. Black or African American A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific islander a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. White A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Student/Staff Name (please print) (Parent/guardian)/ (Staff) Signature Student/Staff Identification Number This space reserved for Local school observer upon completion and entering data in student software system, file this form in the student s permanent folder. Ethnicity choose only one: Race choose one or more: Hispanic / Latino American Indian or Alaska Native Not Hispanic / Latino Asian Black or African American Native Hawaiian or Other Pacific Islander White Observer Signature: Campus and : Texas Education Agency March 2010 Page 2

3 HOME LANGUAGE SURVEY-19TAC Chapter 89, Subchapter BB TO BE COMPLETED BY PARENT OR GUARDIAN (OR STUDENT IF GRADES 9-12): The state of Texas requires that the following information be completed for each student that enrolls for the first time in Texas public schools. This survey shall be kept in each student s permanent record folder. DEBE DE COMPLETARSE POR EL PADRE/MADRE/ O REPRESENTANTE LEGAL: (O POR EL ESTUDIANTE SI ESTA EN LOS GRADOS 9-12): El estado de Texas requiere que la siguiente información se complete para cada estudiante que se matricula por primera vez en una escuela pública de Texas. Este cuestionario se archivará en el expediente del estudiante. NAME OF STUDENT NOMBRE DEL ESTUDIANTE CAMPUS GRADE ESCUELA GRADO 1. What language is spoken in your home most of the time? Qué idioma se habla en su hogar la mayoría del tiempo? 2. What language does your child speak most of the time? Qué idioma habla su hijo la mayoría del tiempo? 3. Place of Birth (Country) Lugar de nacimiento (país) If born outside the United States, has your child ever attended school in the United States? Si nacio fuera de los Estados Unidos, ha asistido su hijo/hija la escuela en los Estados Unidos? Yes/Si No If yes, where?: Si han asistido, donde? s/fechas: 4. Has your child lived outside of the US for 2 or more consecutive years? Yes/ Sí No Ha vivido su hijo(a) fuera de los Estados Unidos por más de dos años consecutivos? 5. Did your child attend school when residing outside of the US? Yes/ Sí No Asistió su hijo(a) a la escuela mientras estuvo fuera de los Estados Unidos? Signature of Parent/Guardian Firma del Padre/Madre/ Guardián Fecha Page 3

4 ENROLLMENT QUESTIONNAIRE and PERMISSION FOR RELEASE OR TRANSFER OF SCHOOL RECORDS Student Name of Birth: Grade: Campus: School Address: Please check all that apply to your child: Has your child attended a Boerne ISD school before? Yes Has your child attended a Texas school before? Yes Is your child receiving any of the following special programs? Special Education 504 No School? No Year/s Migrant At-risk Speech Title I Has your child ever been retained? Yes No If yes what year? Student s Previous School Information School Name District Address City State Zip Phone Fax YOUR SCHOOL DISTRICT IS AUTHORIZED TO FORWARD ALL RECORDS TO THE BOERNE INDEPENDENT SCHOOL DISTRICT Please forward the following records Attendance Records Health Records/ Immunizations Standardized Testing Results Language Survey STAAR Results SPED Academic Records/Grades/ Transcript State ID and/ Social Security Birth Certificate Withdrawal Forms Special Programs 504 Parent/ Guardian Signature Page 4

5 Boerne ISD Required Documents for Student Registration 1. PARENT/GUARDIAN PHOTO I.D. (with current physical address) A driver s license, I.D., or any other photo I.D. is acceptable 2. DOCUMENTATION OF CHILD S DATE OF BIRTH Birth Certificate, Hospital Certificate, Adoption Records or Military ID 3. CHILD S SOCIAL SECURITY CARD If student does not have a Social Security number, a state number will be assigned. 4. IMMUNIZATION RECORDS Required by state law. Immunization Requirements 5. PROOF OF ADDRESS a) If you OWN your home, please bring one of the following: Purchase contract with possession date (not closing date) Current Electric, Water or Gas Bill b) If you RENT, please bring one of the following: Current Electric, Water or Gas Bill Signed Lease or Rental Agreement, including start date c) If you are living with another family, ALL OF THE FOLLOWING ARE REQUIRED: A notarized form (Affidavit of Residence) available at any campus Proof of address from the owner of the home (Electric, Water or Gas Bill) 6. LAST ATTENDED SCHOOL INFORMATION Report Card and or Withdrawal Form Name, address, phone and fax number of previous school withdrawal date from previous school Transcripts for students entering middle or high schools Updated 4/17