GILBERT PUBLIC SCHOOLS GLOBAL ACADEMY

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1 GILBERT PUBLIC SCHOOLS GLOBAL ACADEMY New Student Registration Full Time Online Student School Year Dear Parents and Students, Welcome to Global Academy! You are enrolling in a program that will allow flexibility and self-paced learning, but will also require motivation and self-discipline. The virtual classroom experience is unique and truly works as a benefit to some students. With the right support and tools in place, online learning can lead to great success. In order to complete the registration process, please carefully read the information below: All portions of this registration packet must be completed and returned to Global Academy before student registration can take place. All of the forms can be filled out online and ed back to Global Academy. Documentation items, such as birth certificates, driver s licenses, etc. can either be dropped off in person to the Global Academy office or can be scanned and ed to Global Academy. Once your registration paperwork is complete, you will receive a phone call to finalize the registration process, which includes selecting courses. We will contact a counselor for course recommendations. At the end of the registration process (within 5-7 business days) you will receive an confirming enrollment in the classes that you have selected. This will provide course log-in instructions as well as other important information. Our office staff is ready and willing to assist with any part of the registration process. Please do not hesitate to contact our office at You may save this registration packet to your computer, fill it out, and it to our office if convenient. Otherwise, you may drop it off in person to our office, located in the portables in the south parking lot of Mesquite High School (500 S. McQueen, Gilbert, AZ 85233). Sincerely, Dr. Peter Bartanen Blended Learning Coordinator Gilbert Public Schools

2 Gilbert Public Schools Global Academy Online Learning Student Enrollment Checklist (for new and re-enrolling full-time Global Academy students) 1. Arizona Department of Education AZ Residency Documentation form -- Requires proof of Arizona residency (see form for details) 2. Parent/Guardian Verification ID required -- Copy of Driver s License / State ID card or -- Guardianship papers 3. Birth Certificate -- State law requires a copy of birth certificate in the student s file. If one is not available, parent has 30 days to comply. If student is 18 years old, he/she must have birth certificate to verify age. 4. Open Enrollment Students -- Only needed if student is currently enrolled with another school outside of Gilbert Public Schools. Clearance from student s principal is needed. An open enrollment (boundary exemption) form must be on file. 5. Withdrawal Slip / Withdrawal Grades -- Students must be withdrawn from their previous school before they can be enrolled full-time at Global Academy. Students must have an unofficial transcript with them at the time of registration. 6. Immunization Records -- State law requires that the parent/guardian must present proof of immunization at the time of enrollment. We can request a copy of the immunization records from the previous school, but the registration will be delayed until the copy is received. 7. Special Needs -- Such as a current IEP or 504 plan. 8. Attendance/Discipline History -- Has the student ever been reassigned to another school due to discipline, suspension, or been expelled from any school district? YES. NO. If so, where? _ 9. AzMERIT/AIMS Scores -- Or equivalent out-of-state test scores 10. Special Circumstances -- Custody paperwork, restraining orders, etc.

3 Gilbert Public Schools Student Enrollment Form (Please save this registration information to your computer, fill out the registration, attach it to an to Legal Name: LAST Suffix (Jr./Sr./I/II) FIRST MIDDLE Female Male Nickname (if any) Former name (if any) Grade Residential Address Number/Street Apt City State ZIP Student Information Contact 1 Home Phone Birth (MM/DD/YYYY) Birth Place: City/State/Country Date Entered US Alternate Address/Student Mailing Other Number/Street City State ZIP Has the student previously attended a GPS school? No Yes Prior school Name District City State Country Student Parent Does the student plan to qualify as an NCAA athlete? No Yes In accordance with federal mandates, the following two questions must be answered: Ethnicity (check only one): No, Not Hispanic/Latino Yes, Hispanic/Latino Race (check all that apply): American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Emergency Contact -> Priority: 1 2 Resides with student Has custody Send mailings Send report cards Legal Name: LAST Suffix FIRST MIDDLE MARITAL STATUS Married Div Sep Single Primary Phone Secondary Phone Additional Phone Home Work Cell Home Work Cell Home Work Cell Mailing Address (if different from student) Primary address Employer Name/Occupation Secondary address Contact 2 Emergency Contact -> Priority: 1 2 Resides with student Has custody Send mailings Send report cards Legal Name: LAST Suffix FIRST MIDDLE MARITAL STATUS Married Div Sep Single Primary Phone Secondary Phone Additional Phone Home Work Cell Home Work Cell Home Work Cell Mailing Address (if different from student) Employer Name/Occupation Primary address Secondary address

4 Contact 3 Emergency Contact -> Priority: 1 2 Resides with student Has custody Send mailings Send report cards Legal Name: LAST Suffix FIRST MIDDLE MARITAL STATUS Married Div Sep Single Primary Phone Secondary Phone Additional Phone Home Work Cell Home Work Cell Home Work Cell Mailing Address (if different from student) Primary address Employer Name/Occupation Secondary address Student Academic History Languages Has the student been identified for any of the following special programs? Special Education No Yes Category: Placement: 504 student No Yes Speech Therapy No Yes English Language Learner (ELL) No Yes Reading Program No Yes Gifted (ALP) No Yes Math Program No Yes Has the student ever received a long-term suspension or been expelled from school? No Yes (If yes, Administrator must approve enrollment): School: Grade: Where: Retained? No Yes Is this student a child of Military Service Personnel? No Yes Is the student a recent immigrant? (In US less than 3 years) No Yes Does the student have refugee status? If yes, please provide documentation with this form (i.e. I-94 card) What is the language that the student first acquired? English Spanish Other: What is the primary language used in the home? (Regardless of the language spoken by the student) English Spanish Other: Please complete the state-required Home Language Survey found in your enrollment packet. No Yes Country of origin: I HEREBY AFFIRM THAT THIS INFORMATION IS CORRECT. I also understand that legal updating of the information on this form is my responsibility and includes submitting proper documentation within 30 days. Signature: Typing your name above acts as your signature and indicates you have provided accurate information. Relationship to student: Student Signature: (if 18 or older) Typing your name above acts as your signature and indicates you have provided accurate information. (Please save this registration information to your computer, fill out the registration, attach it to an to

5 Online Learning Agreement Global Academy Full-Time Students (revised July 2017) Dear Parents and Students, Gilbert Public Schools is committed to providing guidance to students and families to increase the likelihood of success in their courses. As part of this commitment, as well as meeting the education laws of Arizona, we are requiring you to complete the contract below. Student Contract I,, agree to work a minimum of 600 minutes per week (online and offline) in each of my courses. This averages to 120 minutes (2 hours) per weekday. I understand that time spent actively working in my online course will be logged as I progress through the course. I also understand that I must log my daily activity (both online and offline) through the Infinite Campus student portal. I understand that I must submit academic assignments on a regular basis. I agree to enroll in a total of courses for the entire school year. In accordance with Arizona Department of Education, Gilbert Global Academy requires that each student complete a minimum of 5,400 minutes per course. The GPS Student Code of Conduct applies to all Global Academy students. The Global Academy Student Handbook describes the procedures and policies that must be followed. I must participate in state-mandated testing (AzMERIT) in accordance with ARS B or I may be removed from Global Academy online learning. Beginning with the 2017 cohort, students must obtain a passing score on the American Civics Act Exam to graduate. I understand that I may be removed from Global Academy if sufficient academic achievement (passing a majority of courses) is not attained in accordance with ARS G. I understand that attending Gilbert Global Academy is a choice and if there is a failure to uphold the above contract, I may be unenrolled from the Global Academy. _ Student Name Student Signature Date _ Parent Name Parent Signature Date (Note: typing a name on the signature lines constitutes a digital signature and indicates agreement.)

6 Office Use Only Signed: AzMERIT TESTING AGREEMENT Student Name: AzMERIT testing is a mandatory requirement for 7-12 th grade students. All full-time enrolled Global Academy students MUST attend AzMERIT state testing. *** State Testing Information All full-time Global Academy students are required to take District and State mandated tests. Test dates cannot be changed. Students in 9 th grade will take the AIMS Science test. Students in grades 9-12 taking or completing the following courses are required to take the End of Course (EOC) AzMERIT state tests: English 1B, English 2B, English 3B, Algebra 1B, Algebra 2B, Geometry B. Students in grades 7 and 8 are required to take the End of Course (EOC) AzMERIT state tests in both English Language Arts and Math. The end of course tests will be given during the following testing windows. Specific dates will be communicated by the Global Academy staff. Fall 2017 EOC Test Window Spring 2017 Test Window Summer School Test Window October 23 November 30, 2017 (writing must be completed by November 17) April 2018 (specific dates TBD) June-July 2018 (specific dates TBD) If you have completed or are currently enrolled in an online Math or English course during the first or second semester of , please plan to attend AzMERIT testing on the dates listed. To learn more about AzMERIT testing, please go to: If you need additional information about testing, feel free to us at By signing below you acknowledge the state of Arizona and Gilbert Public Schools requirement for testing. You also understand your student is required to attend on these dates. Parent signature: ** Typing your name above acts as your electronic signature. Student signature: ** Typing your name above acts as your electronic signature. Testing Center Location: The testing center is located at 500 South McQueen Road, Gilbert AZ We are on Mesquite High School s campus in the south parking lot. The test will be administered at 9:00am each day. Please bring Photo ID with you on the date of your testing.

7 Gilbert Public Schools Global Academy Records Office Fax Cover Sheet 500 S. McQueen, Gilbert AZ Office: (480) Fax: (480) Website: Request for Student Records (This document is important! Complete all information below. At a minimum, we must have a phone number of the school the student last attended.) In accordance with the Family Educational Rights and Privacy Act and Arizona State Law, I hereby authorize the release of student information for: Student s name: Grade Birth Date Previous School Name Address Phone Number Fax Number City State ZIP Code PLEASE FAX UNOFFICIAL RECORDS AND MAIL OFFICIAL TRANSCRIPT. DO NOT SEND CUM FOLDERS. Please include the following information: Official Transcript Please mail Jr. High Transcript/Proof of Promotion Unofficial Transcript Please fax ASAP Withdrawal Slip and Transfer Grades IEP/Psychological Records AzMERIT/AIMS/Achievement Test Scores (9-12) Immunization Records Birth Certificate Discipline and Attendance Records AZELLA/ELL Test Records Legal Guardianship or Custody Paperwork Parent/Guardian Signature: ** Typing your name above acts as your signature and releases the above selected student records to Gilbert Global Academy. Global Academy Records Official Signature _ Date Office Use Only: 1 st Fax 2 nd Fax 3 rd Fax

8 State of Arizona Department of Education Office of English Language Acquisition Services Primary Home Language Other Than English (PHLOTE) Home Language Survey (Effective April 4, 2011) These questions are in compliance with Arizona Administrative Code, R (B)(1), (2)(a-c). Responses to these statements will be used to determine whether the student will be assessed for English Language Proficiency. 1. What is the primary language used in the home regardless of the language spoken by the student? _ 2. What is the language most often spoken by the student? 3. What is the language that the student first acquired? Student Name Student ID Date of Birth _ SAIS ID _ Parent/Guardian Signature _ Date (Typing your name above acts as your signature) District or Charter School Please provide a copy of the Home Language Survey to the ELL Coordinator/Main Contact on site. In SAIS, please indicate the student s home or primary language West Jefferson Street, Phoenix, Arizona

9 Gilbert Public Schools MEDICAL EMERGENCY CARD Student Last Name First Name Date of Birth Grade ID # Address City Zip Code Home Phone # Father/Guardian Name Cell Phone # Company Name Business Phone # Mother/Guardian Name Cell Phone # Company Name Business Phone # Student resides with: Mother and Father Mother Father Joint Custody Other IN CASE OF EMERGENCY: Name of persons who could assume temporary responsibility: Local friend or relative: Local friend or relative: Local doctor: Phone: Phone: Phone Local hospital: Emergency Health Information 1. Does this student have any health problems? No Yes If Yes, please explain: 2. Asthma Bee stings/severe allergy Seizures Diabetic Other: 3. Daily medications: I, the undersigned parent/guardian, hereby give my consent for the above named child to be released to the friend/relative I have designated and/or to the nearest hospital in case of emergency. Signature of Parent/Guardian: ** Typing your name above acts as your signature ** Please note that treatment in the emergency room will require your presence.

10 Please scan and a copy of the documentation requested below, or bring it in person to the Global Academy office. Arizona Department of Education Arizona Residency Documentation Form Student School School District or Charter Holder Parent/Legal Guardian As the Parent/Legal Guardian of the Student, I attest that I am a resident of the State of Arizona and submit in support of this attestation a copy of the following document that displays my name and residential address or physical description of the property where the student resides: Valid Arizona driver s license, Arizona identification card or motor vehicle registration Valid U.S. passport Real estate deed or mortgage documents Property tax bill Residential lease or rental agreement Water, electric, gas, cable, or phone bill Bank or credit card statement W-2 wage statement Payroll stub Certificate of tribal enrollment or other identification issued by a recognized Indian tribe that contains an Arizona address. Documentation from a state, tribal or federal government agency (Social Security Administration, Veteran s Administration, Arizona Department of Economic Security) I am currently unable to provide any of the foregoing documents. Therefore, I have provided an original affidavit signed and notarized by an Arizona resident who attests that I have established residence in Arizona with the person signing the affidavit. _ Signature of Parent/Legal Guardian _ Date #

11 If using this form, it must be completed, signed, and notarized offline and returned to the Global Academy office. State of Arizona Affidavit of Shared Residence I swear or affirm that I am a resident of the State of Arizona and that the persons listed below reside with me at my residence, described as follows: Persons who reside with me: Location of my residence: I submit in support of this attestation a copy of the following document that displays my name and current residence address or physical description of my property: Valid Arizona driver s license, Arizona identification card or motor vehicle registration Valid U.S. passport Real estate deed or mortgage documents Property tax bill Residential lease or rental agreement Water, electric, gas, cable, or phone bill Bank or credit card statement W-2 wage statement Payroll stub Certificate of tribal enrollment or other identification issued by a recognized Indian tribe. Documentation from a state, tribal or federal government agency (Social Security Administration, Veteran s Administration, Arizona Department of Economic Security) Printed Name of Affiant: Signature of Affiant: Acknowledgement State of Arizona County of The foregoing was acknowledged before me this _ day of, 20_, By. _ Notary Public My Commission Expires: #

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