Immunization Records NEW IMMUNIZATION REQUIREMENTS: K-12 students must have a TN School Immunization Certificate showing: Two (2) doses of Varicella

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1 March 24, 2014* Grades 1 & 2 Grade 8 *Incoming grade Enrollment Night Information Town of Collierville Residents Only March 25, 2014* Grades 3 & 4 Grade 7 March 27, 2014* K and Grade 5 Grade 6 Bus transportation is not provided for Enrollment Night. Self-Contained Special Education Students in self-contained Special Education classes will register on August 4, 2014, the first full day of school, and do not need to be present on Enrollment Night (March 24, 25 or 27). Parents are encouraged to contact the school and speak with the Special Education Secretary to confirm enrollment prior to the first day of class. Items Needed for Enrollment *Proof of Residence: Parents/guardians must provide TWO of the following items showing the parent/guardian s name and address to prove residency: 1. Most recent MLGW or municipal water bill of the owner, renter or lessee of the home in which the student will reside during the current school year; 2. Mortgage statement or deed of the owner of the home in which the student will reside during the current school year; 3. Lease of the lessee of the home in which the student will reside during the current school year; 4. Rental Agreement of the renter of the home in which the student will reside during the current school year; 5. Real Estate tax receipt; 6. Public assistance/government benefits check, card, or papers; 7. In the event that two (2) of the items listed above cannot be provided, residency may be established by submitting other documentation deemed to be appropriate proof of residence by the department responsible for verifying residency. Immunization Records NEW IMMUNIZATION REQUIREMENTS: K-12 students must have a TN School Immunization Certificate showing: Two (2) doses of Varicella Four (4) doses of DTP- Two (2) doses of MMR Four (4) doses of Polio or proof of Chickenpox Hib-Td (all students) Two (2) doses of Tdap Booster Three (3) doses of Hepatitis Hepatitis A (Grade K); (7 th Grade Entry Only) B (Grade K & 7) For more on state-required immunizations, please refer to the Immunization Requirements at the following state website: New Student Enrollment Students who have previously enrolled in another school system in Tennessee may enroll pending receipt of their academic and health records. Students transferring into the system from an out of state school or from a nonpublic school must provide a Tennessee Department of Health Immunization Certificate that includes a physical exam. The following documents are required: 1. Proof of Residence: Same as above. Proof of residence is required of all students at enrollment and may be required of any student during the school year. 2. Social Security Number: Bring student s Social Security Card. (T.C.A ) 3. Tennessee Department of Health Immunization Certificate: Contact the school for additional information. 4. Kindergarten Students must be 5 years old on or before August 15, 2014, and the following items must be provided: A. Certified copy of Birth Certificate B. Proof of recent medical examination C. Tennessee Department of Health Immunization Certificate with proof of a physical exam within 12 months prior to enrollment. D. Social Security Card E. If applicable, custody papers and parent plan offers educational and employment opportunities without regard to race, color, creed, national origin, religion, sex, age, or disability and adheres to the provisions of the Family Education Rights and Privacy Act (FERPA).

2 March 24, 2014* Grades 1 & 2 Grade 8 *Incoming grade Frequently Asked Questions About Enrollment Night 2014 March 25, 2014* Grades 3 & 4 Grade 7 1. What are the dates and times for the enrollment night? Please see the table above for dates and times for enrollment. March 27, 2014* K and Grade 5 Grade 6 2. What school should I attend to enroll my child? Parents should enroll their child at the school he/she will be attending for the school year (i.e., current 5 th graders report to assigned middle school and current 8 th graders report to high school). 3. Who should attend enrollment night? All Town of Collierville students zoned for for the school year. Students currently attending a Collierville school and not zoned for (CS) should not attend. If not zoned for CS for , please complete a non-resident form available on our website. 4. If I attend enrollment night, do I have to attend regular registration on July 29, 2014? Yes. You must attend the regular registration on July 29 to pick up teacher assignments, class schedules and transportation information; otherwise, all enrollment data will be purged. Proof of residence will not be required on July 29 if previously presented on enrollment night. 5. What will I need to bring with me on enrollment night for students enrolling in grades K 12? Proof of Residence - At registration, parents/guardians must provide TWO of the following items showing the parent/guardian s name and address to prove residency: 1. Most recent MLGW or municipal water bill of the owner, renter or lessee of the home in which the student will reside during the current school year; 2. Mortgage statement or deed of the owner of the home in which the student will reside during the current school year; 3. Lease of the lessee of the home in which the student will reside during the current school year; 4. Rental Agreement of the renter of the home in which the student will reside during the current school year; 5. Real Estate tax receipt; 6. Public assistance/government benefits check, card, or papers; 7. In the event that two (2) of the items listed above cannot be provided, residency may be established by submitting other documentation deemed to be appropriate proof of residence by the department responsible for verifying residency. SEE ENROLLMENT IMMUNIZATION REQUIREMENTS ON PAGE 2 BELOW.

3 Immunization Records: K-12 students must have Tennessee School Immunization Certificate showing: Two (2) doses of MMR Two (2) doses of Hepatitis A (Grade K); Two (2) doses of Varicella or proof of Chickenpox Tdap Booster (7 th grade entry only) Four (4) doses of Polio Three (3) doses of Hepatitis B (Grade K & 7) Four (4) doses of DTP- Hib-Td (all students) 6. For students to enter kindergarten, the student must be five (5) years of age on or before August 15. What will I need to bring with me on enrollment night for students enrolling in kindergarten? Birth Certificate (Certified Copy Only Not Mother s Copy) Social Security Card (Actual Card) Physical with Immunization Record (will be accepted on July 29, 2014, also) Parenting Plan and Custody Papers Driver s License (for identification only) 7. What if I am assigned to a school, but I want to attend another school in Collierville? Report to the school where you want to attend and complete a student transfer form, as well as other required documents. For example, if you current attend one Collierville elementary school and would like to attend another Collierville elementary school in the Fall attend that school for early registration. You will receive notification later in the Spring regarding acceptance. 8. What is the difference between a non-resident student and a transfer student? Non-resident students are those who are not zoned to attend. Transfer students are those students residing in the district who wish to attend a different school within the (doesn t apply to high school). 9. Who around Collierville is considered a non-resident student for? Anyone residing in the Collierville Reserves or in any other municipality or area outside the boundaries of the Town of Collierville. 10. If I completed a Non-Resident Application for, do I need to attend enrollment night? No. You will be notified on the status of your non-resident application during April. 11. Who pays tuition? Students who live outside of Shelby County will be required to pay tuition. 12. What about shared residency? Shared residency will be accepted on the enrollment nights of March 24, 25, or 27. If you have shared residency, please report to the school with all required paperwork.. offers educational and employment opportunities without regard to race, color, creed, national origin, religion, sex, age or disability and adheres to the provisions of the Family Rights and Privacy Act (FERPA).

4 Items Accepted for Proof of Residence Please provide two (2) of the following seven (7) items showing the parent/guardian s name and address to prove residence: 1. Most recent MLGW or municipal water bill of the owner, renter or lessee of the home in which the student will reside during the current school year; 2. Mortgage statement or deed of the owner of the home in which the student will reside during the current school year; 3. Lease of the lessee of the home in which the student will reside during the current school year; 4. Rental Agreement of the renter of the home in which the student will reside during the current school year; 5. Real Estate tax receipt; 6. Public assistance/government benefits check, card, or papers; 7. In the event that two (2) of the items listed above cannot be provided, residency may be established by submitting other documentation deemed to be appropriate proof of residence by the department responsible for verifying residency. Any child up to the eighteenth birthday whose parents are bona fide residents of Collierville is entitled to attend. Only the residence of the parent with legal custody may be used for registration. (T.C.A ) In cases where parents have joint custody, only the address of the parent named as the primary custodian or designated primary responsibility to determine educational issues may be used for registration. The parent whose residence qualifies the child to be registered is the parent the school personnel will consider as the custodial parent. The noncustodial parent may receive school records when a written request is given to the school principal in compliance with T.C.A or T.C.A Any child who has been legally adopted by persons who are bona fide residents of Collierville is entitled to attend (CS Board Policy 6.204). Wards of the Juvenile Court who have been placed in custody of a bona fide resident of Collierville are entitled to attend (CS Board Policy 6.204). Any child approved under the non-resident policy is entitled to attend (CS Board Policy 6.204). policy prohibits the enrollment of any student other than the above described. Any parent, guardian, or other legal custodian who enrolls an out-of-district student in a school district and fraudulently represents the address for the domicile of the student for enrollment purposes is liable for restitution to the school district for an amount equal to the local per pupil expenditure identified by the Tennessee Department of Education for the district in which the student is fraudulently enrolled. Any parent, guardian, or other legal custodian who enrolls an out of-state student in a school district and fraudulently represents the address for the domicile of the student for enrollment purposes is liable for restitution to the school district for an amount equal to the state and local per pupil expenditure identified by the Tennessee Department of Education for the district in which the student is fraudulently enrolled. offers educational and employment opportunities without regard to race, color, creed, national origin, religion, sex, age, or disability and adheres to the provisions of the Family Rights and Privacy Act (FERPA).

5 Student Enrollment Form For School Use Only: Birth Cert Physical Immunization Cert SS Card Proof of Residence: Mortgage Lease Rental Agreement Sales Contract Real Estate Tax MLGW/Water Bill Public Assistance Docs Military Housing Letter Other deemed appropriate by school admin (list) Proof of residence if living with someone else: Notarized Proof of Residence Form Completed Administrative Approval Teacher Date of enrollment Bus RT# Daycare Car Walker Has student ever attended another Tennessee Public School? Yes No Last School Attended Has student ever attended a Shelby County (or Memphis City) school? Yes No School Name Address City State Student Social Security Number Student s Legal Last Name First Name Middle Name Birth Date (mm/dd/yyyy) Generation (Jr, II, etc.) Gender Male Federal Ethnic Category: Hispanic or Latino Federal Race Category: Mark one or more races to indicate what you consider your child to be. (Even if Hispanic or Latino has been chosen for ethnicity, the child must be recorded as being one or more of the following races.) Asian Female Not Hispanic or Latino White Student s Physical Address (Address of Parent/Legal Guardian) American Indian or Alaska Native Native Hawaiian and Other Pacific Islander Black/African-American Grade Level Street Number Street Name Apartment City State Zip Parent/Legal Guardian #1 Title (Mr., Mrs, etc.) Last Name First Name Middle Name Generation Preferred Language English Spanish Other Translator Needed? Yes No Home Phone Work Phone Cell Phone Relationship Student Lives With Mother Father Employed By Federal Employee Yes No Parent/Legal Guardian or Other Contact #2 Both Other Title (Mr., Mrs, etc.) Last Name First Name Middle Name Generation Preferred Language English Spanish Other Translator Needed? Yes No Home Phone Work Phone Cell Phone Relationship Student Lives With Mother Father Employed By Federal Employee Yes No Both Other Emergency Contact #1 Title (Mr., Mrs, etc.) Last Name First Name Middle Name Generation Preferred Language English Spanish Other Translator Needed? Yes No Home Phone Work Phone Cell Phone Relationship List siblings attending Name Birth Date Gender Grade School Are there any Legal Alerts the school needs to be aware of? Yes No If Yes, please explain and provide appropriate documents (for example, court orders). Has the student ever been enrolled in a Special Education/Resource/504/Gifted Program? Yes No If yes, what type of program? Where? When? Student s Birth Place (City) Birth State Birth Country If Immigrant, Date Entered U.S. Year Started School First Date Enrolled in U.S. School (mm/dd/yyyy) (yyyy) (mm/dd/yyyy) Mother s Maiden Name Birth County Birth City Is English primary language spoken by student? Yes No Is English language limited? Yes No List Home Language offers educational and employment opportunities without regard to race, color, creed, national origin, religion, sex, age, or disability and adheres to the provisions of the Family Rights and Privacy Act (FERPA).

6 Primary Home Language Survey The parent or legal guardian should complete this form during registration. Date Student Name Sex Date of Birth School Grade Student # Home Telephone Cell Phone The native/home language of each student must be recorded in his/her permanent record. Please answer the following questions about your child s language background: 1. What is the first language this child learned to speak? 2. What language does this child speak most often outside of school? 3. What language do people usually speak in the child s home? Listing another language other than English to any of the questions above DOES NOT qualify a student as an English language learner. It does require, however, that the student participate in an approved language proficiency assessment to determine language proficiency and possible ESL classification based on these assessment results. If any question is answered with another language other than English, a copy of this form should be forwarded to the local school ESL teacher for language assessment testing. Collected for Funding Purposes Only: Was this child born in the United States? Yes No If no, what is the country of birth? Date entered the United States: Date entered schools in the United States: Has this student ever been enrolled in an ESL program? Yes No In what language do you want correspondence sent to you from school? Signature of Parent/Guardian offers educational and employment opportunities without regard to race, color, creed, national origin, religion, sex, age or disability and adheres to the provisions of the Family Rights and Privacy Act (FERPA). Revised 03/2014