Residential Students must fill out enrollment forms at the Home Livings Office you may contact Ms. Yazzie at (505) or (505)

Transcription

1 Wingate High School - Admissions and Records P.O. Box 2 - Ft. Wingate, New Mexico Ph# (505) Fax# (505) New Student Enrollment (First Day of School July 31, 2017) Student: Grade Complete all forms and return to the Registrar s Office or mail to the above address. All required documents must be attached to your enrollment packet. The completed enrollment packet will determine eligibility for school enrollment. Forms Check Off List: Enrollment Application Map of Home location Health Consent Indian Health Service School Physical Health History Required Documents: (No exceptions) Updated Immunization Record Certificate of Indian Blood Birth Certificate Unofficial - High School Transcript First Year Freshman require proof of promotion to 9 th grade. (Final 8 th grade report card) Other Forms/Documents: Dorm Registration Transportation: Bus Pass Boarding Day Student Contract Guardianship Documents Sports Physical Form IEP: Sp. Ed., Gifted & Talented or Bilingual Programs. Check out cards: Residential Academic New students transferring from another high school: You must have an unofficial copy of your transcript upon enrolling, no exception. It is your responsibility to obtain one from the last school you attended. Students promoted to 9 th grade must bring a copy of last report card that shows your promotion. You must have completed 8 th grade with passing grades to be accepted. Wingate High School upholds suspensions and expulsions of other schools. Any student expelled from another school will be not accepted. Suspensions and expulsions must be cleared with the last school attended before enrolling. Day Students must complete a Day Student Contract upon registration. Forms are available at the Registrar s Office upon request. Parking permits are required for students driving. Residential Students must fill out enrollment forms at the Home Livings Office you may contact Ms. Yazzie at (505) or (505)

2 BIE form 6248 OMB No WHS/Rev. 03/2012 D34N21 UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF INDIAN EDUCATION WINGATE HIGH SCHOOL (Home of the Bears) STUDENT ENROLLMENT APPLICATION School Year Grade Day Dorm ********************************************************************************************************************************************* (Student must be enrolled with an Indian Tribe or at least have ¼ Indian Blood to be eligible for BIE school enrollment.) Name of Student: (Last) (First) (Middle) Male: Female: Date of Birth: Tribal Enrollment #: Degree of Indian Blood: Tribe: Home Agency: Primary Language Spoken by Student: Navajo English Navajo/English Other Documents Provided: Certificate of Indian Blood Birth Certificate Immunization Record (optional) SS# (You must provide a copy of unofficial transcript from last school attended, 8 th grade report card and promotion certificate.) Last school attended: Address: Dates attended: Grade(s): Transcript: Reason for leaving: Other school(s) attended: Address: Dates attended: Grade(s): Transcript: Reason for leaving: Services provided by the last school attended. (Please answer all of the following questions) Special Education: Yes No Bilingual: Yes No Gifted & Talented: Yes No Have you been expelled? Yes No Suspended? Yes No Reason: If you answered yes, you will need an administrator s approval before proceeding. Approved Disapproved Contract Hold Sign:

3 HOUSEHOLD INFORMATION: Do parents live in one household? Yes No Student lives with: Relationship: Father: Mother: Home Phone #: Home Phone #: Cell Phone#: Cell Phone #: Work Phone #: Work Phone #: Chapter: Chapter: Who receives mail from school? (Check one) Father Mother Both Father s Mailing Address: Mother s Mailing Address: Physical Address: Household members attending Wingate High School: Emergency Contact: Phone: Relation to student: Emergency Contact: Phone: Relation to student: GUARDIAN INFORMATION: (Complete only if you are a legal guardian, you must provide guardianship documents) Legal Guardian: Relationship: Mailing Address: Physical Address: Cell Phone: Home Phone: Work Phone: Message Ph.# Emergency Contact: Relation: Phone #: Documents: Legal Guardianship Papers: Power of Attorney: Other:

4 ENROLLMENT RESTRICTIONS: Students expelled from prior school: 1. Any student who has been expelled from or left any high school because of an incident involving a weapon or violence will not be allowed to enroll at Wingate High School for a period of no less than one calendar year from the date of that expulsion or withdrawal. 2. Suspensions/expulsions and/or any other disciplinary actions handed down by another school must first be completed and cleared with the last school attended, before he/she is accepted for enrollment at Wingate High School. 3. If a student has left another school in lieu of a pending disciplinary action such as suspension, expulsion, or due process hearing, that student may not enroll at Wingate High School until an official decision has been made. Therefore if a student leaves a school under the threat of possible suspension or expulsion he/she may not enroll at Wingate High School. Age Requirement: 1. Students applying for admission will not be approved if his/her birthday, grade classification or enrollment date make it chronologically impossible for them to graduate from high school before they turn 21 years of age. A student may not enroll in a Bureau of Indian Education School if he/she turns 21 years old during the current school year. 2. First year freshmen must complete all eighth grade requirements to be eligible for enrollment. Freshmen who are 17 years old or older will not be approved for enrollment. Out of Boundary Students: 1. Out of boundary students who withdraw from Wingate High School before the school year ends are responsible for travel expenses to their home destination. 2. Out of boundary students need special approval by their home Agency s Office of Indian Education. 3. All out of boundary enrollment applications and documents due date is July 30th. I am legally responsible for this student and hereby apply for his/her admission to Wingate High School and consent for emergency medical care. Information provided is accurate. I will provide updated information to the school when changes occur. Signature of Parent/Legal guardian Date Student who lives outside of Navajo Reservation must submit complete enrollment application by July 30, to be considered for approval, no exceptions. (Including all documents required) Enrollment for this student is: Approved Not Approved Signature of Approving Official Date This student lives within the attendance boundary as established for Wingate High School or has obtained the necessary approval from his/her home Agency to attend Wingate High School. Wingate High School Enrollment: Approved Not Approved Signature of School Principal Date

5 Wingate High School STUDENT HOME MAP AND INFORMATION FORM Student s Name Grade Day Student/Dorm # Student lives with: Home Telephone No.: Work Telephone No.: Physical home location: Use the building below as an indicator of a local public building (e.g. church, school, chapter house, or a store) near your home that can be easily identified in your community. Give mileage and road number to your home. (North) (South) House No. NHA House Mobile Color Brick Hogan Color Stucco Log Color Apartment Other I certify that this is true and correct information of my home location. Parent/Guardian Date: Revised 4/17/12 NY

6 DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC HEALTH SERVICE INDIAN HEALTH SERVICE CONSENT OF PARENT OR LEGAL GUARDIAN OR OTHER PERSON1 WHO HAS PRIMARY RESPONSIBILITY FOR THE CARE OF THE CHILD (Before completing this form, please read information on reverse side.) Name of Student Birth Date I (We), Have read the Consent Form for the Indian Health to arrange for or to provide the following health services for this child: 1. Health care including medical examinations, routine laboratory studies, x-ray procedures, and skin tests. 2. Dental care including dental examinations, preventive use of fluorides and necessary emergency dental care. 3. Mental health services including evaluation and treatment as necessary. 4. Emergency health care for accidents or illness. 5. Transportation of the child to and/or from another health facility for these services. I hereby give consent for all of the above services. Exceptions or Special Instructions: Signed Address Relationship Date Valid Until:

7 STUDENT HEALTH HISTORY STUDENT NAME: BIRTHDATE: (Parents: Please fill this form out completely by answering Y=Yes and N=No for each question) HEALTH HISTORY: Y N Has your child had measles, chicken pox, whooping cough, pneumonia, asthma, heart problems such as a murmur or hepatitis? (Circle any that apply) Y N Does your child have any chronic illnesses such as heart problems, asthma, high blood pressure, seizures or diabetes? (Circle any that apply) Y N Has your child ever been hospitalized or had surgery? Y N Has your child ever been knocked out, had a concussion or serious head injury? Y N Has your child ever had a seizure, fit or convulsion? Y N Does your child have any missing organs such as an eye, kidney, testicles, etc.? Y N Does your child have fainting or dizzy spells? Y N Does your child often have headaches not relieved by rest or pain reliever? Y N Has your child had a shoulder, knee or ankle injury? Y N Has your child had a broken bone? Y N Has your child had more than three ear infections? Y N Does your child have braces, a dental bridge or plate? Y N Does your child have chest pain with exercise? Y N Do you have any concerns about your child being in sports? Y N Does your child have any allergies (to food, animals, plants, etc.)? Y N Does your child take any medication on a daily basis for a chronic medical problem? Y N Is your child allergic to any type of medication? LIST MEDICATIONS HERE: If you answered yes to any questions above, please provide additional information: FAMILY HISTORY: Y N Are there any health issues in your family like diabetes, heart problems, cancer, stroke, tuberculosis, asthma, seizures or any inherited disease? Y N Is there anyone in your family who had a sudden, unexplained death under age 40? Y N Do you have other children with serious health problems? If you answered yes to any questions above, please provide additional information: OTHER HEALTH CONCERNS: Y N Does your child have trouble hearing, seeing or talking? Y N Does your child wear glasses or contact lenses? Y N Does your child have problems in school? Y N Does your child have behavior problems? If you answered yes to any questions above, please provide additional information: If you have any other health concern other than those listed in this questionnaire, please provide info: PARENT/GUARDIAN SIGNATURE: DATE:

8 Wingate High School Student Off-campus Checkout Procedure All students are required to check out through the attendance office and from the residential hall at all times. No Checkouts from 2:00 3:00 p.m. from Monday Thursday. No Checkouts from 8:00 a.m. 3:00 p.m. on Friday. Only immediate family members defined as a mother, father, brother, sister, grandparent, uncle and aunt can check-out a student. No checkouts will be granted to anyone without a written and signed request by the student s parents or legal guardians. Students are not allowed self-checkout regardless of age. An adult less than 25 years of age and/or under the influence of alcohol or drugs is not allowed to check out a student. This applies to all parties, including family members. Any school personnel are not allowed to check-out a student(s) at any time (i.e. Overnight, weekdays and weekends), unless they are the parent of the student as stated in the employee handbook. Check-out request via telephone will not be approved except in situations where a family emergency involving a serious illness or death of an immediate family member are involved. This serves as a written document signed by the parent or guardian, stating that the school is released of any liability associated with the check-out. Bus Permissions Forms must be signed by the parent for bus passes to be issued and approved by school personnel. STUDENT CHECKOUT CARD Student s Name: Grade: DOB: Mother s Name: Phone No.: Father s Name: Phone No.: The following individuals have my permission to check out my child during the school year. 1. Relation: 2. Relation: 3. Relation: 4. Relation: Parent/Guardian Signature Date

9 ATTACHMENT A BUREAU OF INDIAN EDUCATION AUTHORIZATION TO ADMINISTER PRESCRIBED/OVER-THE-COUNTER MEDICATION PART I TO BE COMPLETED BY THE PARENT/GUARDIAN I hereby request and authorize designated and properly instructed school personnel to administer prescribed medication as directed by the prescribing physician or other duly licensed provider (PART II below). I certify that I have legal authority to consent to the administration of prescribed medication following the provider s order. I understand additional prescriber/parent authorizations will be necessary for each medication to be administered, and if the dosage of the medication is changed. If necessary, I authorize the designated school health care official to communicate with the prescriber or the student s health care provider as allowed by HIPAA. STUDENT INFORMATION Student Name Date of Birth Gender M F Last First MI School Grade School Year Height (inches) Weight (lbs) List all medication(s) student is taking, including over-the-counter medication(s): List any known drug allergies/reactions: Parent/Guardian Signature Date Contact Number(s): (Day) (Evening) PART II TO BE COMPLETED BY THE PRESCRIBER PLEASE USE A SEPARATE FORM FOR EACH MEDICATION Name of Medication: Diagnosis: Dosage: Time(s)/Frequency to be given: Route of Administration: PRN (as needed) Yes No If PRN, (signs/symptoms): Side Effects: Begin Medication: Stop Medication: Date Date Special Instructions: Refrigeration required? Yes No Is medicine a controlled substance? Yes No Is this an emergency self carry/self administration medication? Yes No Has student been instructed in the proper self administration of medicine? Yes No Prescriber s authorization for self carry/self-administration of emergency medication: Signature Date Prescriber s Name/Title: Phone (Type or Print) Address: Fax Prescriber s signature: Date PART III TO BE COMPLETED BY School Nurse/Other Duly Licensed Health Care Provider Parts I and II above are completed, including signatures. Prescription medication is properly labeled by a pharmacist and within the expiration date. Medication label and prescriber order are consistent. Over-the-counter medication is in an original container with manufacturer s dosage label intact. Release #16-4, Issued: 11/04/15 New ATTACHMENT B Principal/Authorized School Personnel Signature Date

10 Parent Consent to Travel School Year July 31, 2017 May 17, 2018 I,, authorize my child, Print Name, to travel with Wingate High Print Name School Staff on (educational, extracurricular and athletic) school sponsored trips. Parent/Guardian Signature: Print Name: Phone Number: In Case of Emergency: Person: Phone Number: Date Signed:

11 Wingate High School commits to: Provide a safe and supportive environment in which learning is emphasized. Provide that Wingate High School remain fully accredited with AdvancED/North Central Association. Lead the staff in providing high-quality curriculum and instructions, based on the Common Core State Standards that will enable all students to reach high academic standards. Provide technology to enhance curriculum and to ensure that our students are prepared to compete in a global economy. Maximize opportunities for all of our students to meet proficiency levels in assessments. Communicate to students and parents about the school s mission and goals. Reinforce the partnership between student, parent, and staff. Provide extracurricular opportunities for learning and growth. Provide opportunities within the Performing and Vocational Arts courses for the student to determine aptitudes and interests and to prepare for various careers. Foster a respect for all cultures and promote strong values. Encourage all students to strive to maintain at least a 3.0 grade point average. Principal s Signature: As a teacher of Wingate High School, I commit to: Respect my students as individuals. Respect and promote traditional and cultural awareness. Respect the parents of my students in their role as first teachers of their children and invite their support. Provide a good role model and pattern for responsible behavior for my students to observe and reflect upon as they grow into adulthood. Utilize research-based curriculum, Common Core State Standards and best practice in my teaching. Maintain high expectations for my students and support their efforts in reaching those expectations, and to be critical thinkers. Teach my students to think and apply knowledge to workplace and real-life situations that they may become productive and responsible adults. Remember that children are sacred and that the assignment to teach them that I have accepted is a sacred obligation. Head teacher s signature: Wingate High School COMPACT Student, Parent, Teachers, & Administration School Year Mission Statement Wingate High School is a Native American School that nurtures the Whole Person in Self-Identity, Education, Leadership and Wisdom. Vision Statement Nurture Your Talent Learning takes place only when there is a combination of effort, interest and motivation. As we are committed to each student s progress at Wingate High School, we are going to utilize our best efforts to ensure career and college ready students.. We believe that this compact will be fulfilled by our team efforts. Together we commit to improve teaching and learning. All students will reach the highest standards that Wingate High School has adopted for academic achievement.

12 As a student, I commit to: As a parent, I commit to: Attend school and class on time every day so I can help the school meet the State requirement for 95% attendance rate and stay current in my studies. Enhance my traditional and cultural awareness Work as hard as I can on my classwork and homework activities. Spend a reasonable amount of time each day studying and attend after school tutoring when needed. Be respectful of others property, feelings, and physical well-being. Ask questions or ask for help when I do not understand something. Discuss with my parents what I am learning at school Strive to reach proficiency in applicable Common Core State Standards. Be proficient on assessments, especially, the NWEA and other assessments required for graduation. Strive to maintain at least a 3.0 grade point average (GPA) to be able to have more post-graduate choices (receive scholarships and acceptance to post-secondary institutions). Select career goals to pursue while attending Wingate High School. Strive for proficiency in technology usage. Be college & career ready upon graduation. Ensure my child attends school every day to help Wingate High School meet the State requirement for 95% attendance rate and help my child stay current in all academic studies. Support and enhance my child s traditional and cultural awareness. Monitor my child s academic progress by studying reports from the school, attending parent-teacher conferences, and questioning my child about his/her progress. Encourage my child to be respectful to self, others, and property. Help and encourage my child to meet proficiency requirements on assessments. Support my child s academic endeavors: tutoring and classroom visitations. Limit television watching at home, stress positive activities, such as reading and community service. Support all school policies and procedures, and be accountable for my child s education. Encourage my child to maintain at least a 3.00 grade point average (GPA). Maintain communication with school, teachers, and have access to the NASIS Parent Portal Visit classrooms, residential, cafeteria, and attend school activities. Encourage and support my child s effort to be college and career ready upon graduation. Student Signature: Parent Signature:

13 Student Internet & Technology Agreement Wingate High School (BIE) SY Student Section Student Name Grade I have read the BIE s Student Internet Use Policy. I agree to follow the rules contained in this policy. I understand that if I violate the rules, my account can be terminated and I may face other disciplinary measures. Student Signature Date I am 18 or older and sign as an adult Date of Birth ******************************************************************************** Parent or Guardian Section I have read the BIE s Student Internet Use Policy. I hereby release the BIE, Wingate High School, its personnel, and any institutions with which it is affiliated from any and all claims and damages of any nature arising from my child s use of, or inability to use, the BIE system, including but not limited to claims that may arise from the unauthorized use of the system to purchase products or services or exposure to potentially harmful or inappropriate material or people. I understand that I can be held liable for damages caused by my child s intentional misuse of the system. I will instruct my child regarding any restrictions against accessing material that are in addition to the restrictions set forth in the BIE policy. I will emphasize to my child the importance of following the rules for personal safety. For Parents or Guardians of Wingate High School Students I hereby do give permission for my child to use the Internet. I understand that includes permission for my child to access information through the World Wide Web, create and use an individual account, engage in other education-related electronic communication activities, and provide personal information to others for education or career development reasons or as approved by school staff. I do NOT give permission for my child to use the Internet. I hereby give permission for the school to post the following information and material on the Internet: (Choose one) Option 1: Students will use limited student identification (e.g. first name and last initial or other school-developed identifier). Group pictures without identification of individual students are permitted. Student work may be posted with the limited student identification and will contain the student s copyright notice (for example, 2013, jjwill, Student at Adams High School). Option 2: Students may be identified by their full names. Group or individual pictures of students with student identification are permitted. Student work may be posted with student name. All student-posted work will contain the student s copyright notice, including the student s name. Option 3: No information or material may be posted. Parent Signature Date Parent Name Home Address Phone Rev dv aup/hb/tech

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