If other than U.S.A., what year did he/she move into the U.S.A? Has the student ever attended school in Minnesota? Yes No

ENROLLMENT FORM (Please PRINT and complete entire form.) Revised 01/2019 STUDENT Full LEGAL Name Last First Middle Birth date Gender Enrolled Grade Primary Home Language MM/DDIYYYY MIF Ethnicity/Race Information Is this student Hispanic/Latino? Yes No 504 Plan Regardless of your answer above, please continue to answer by checking all that apply to indicate the student's race: American Indian/Alaskan Native Asian Black/African American Native Hawaiian/Pacific Islander White (This information is used for reporting ethnic ccmposition for Has the student received any of the following senices? Title 1 English Language Learner Gifted and Talented Special Education: Current IEP/IFSP D Yes No If yes, please check any of the following: Emotional/Behavior (EBD) Developmental Cognitive Disability (DCD) Specific Learning Disability (SLD) Autism Spectrum Disorders Other Does the student have any special health administrative and Office of Civil Rights purposes. It will be treated in problems? D Yes No accordance with the Federal Data Privacy Act of1974 and State of Minnesota Privacy Law.) If yes, please describe Student's birth country? If other than U.S.A., what year did he/she move into the U.S.A? Has the student ever attended school in Minnesota? Yes No Has the student attended ISO 199 schools before? Yes No For Kindergarten only: Has your child been screened? Yes No If so, WHERE? Last school attended Grade attended City, State Date of attendance Inver Grove Heights Schools does not discriminate in employment or in any of its programs and activities, including vocational opportunities, on the basis of race, color, creed, religion, national origin, sex, marital status, status with regard to public assistance, familial status, membership or activity in a commission, disability, sexual orientation, or age. Inver Grove Heights Schools provides equal access to designated youth groups. /SD 199 Director of Human Resources Michele Carroll. 651-306-7805 and Carrol/M@isd199.org, has been designated to respond to employment-related inquiries regarding the non-discrimination policies including Title IX. /SD 199 Director of Special Services Mary Garrison, 651-306-7827 and GarrisonM@isd199.org, has been designated to respond to student-related inquiries regarding the non-discrimination policies including Title IX and to inquiries concerning the rights of a student with a disability (504 Coordinator). The mailing address for all directors is: 2990 80th Street East, Inver Grove Heights, MN 55076. OFFICE USE ONLY Home room# School# Begin Enrollment Date Teacher/Counselor Student ID# LLC Prev Dist Transportation Code Family# Resident District To SPED Verify IEP State Aid Code Verify address residency Verify birth certificate THIS IS A TWO-SIDED FORM

ADDRESS Legal Parent/Guardian #1: Parent/Guardian #2: Revised 01/2019 Name Address Apt # Is this a permanent address? Yes No Move in date Dwelling Type: Single Family Apartment Townhouse Duplex Condominium Mobile Home Primary Language Require Interpreter Yes No Birth Date (MM/DD/YY) Primary Phone Work Cell E-mail Gender M/F Legal Relationship to student: Name Address Apt # Is this a permanent address? Yes No Move in date Dwelling Type: Single Family Apartment Townhouse Duplex Condominium Mobile Home Primary Language Require Interpreter Yes No Birth Date (MM/DD/YY) Primary Phone Work Cell E-mail Gender M/F Legal Relationship to student: If more than one address listed, where does student reside? Parent/Guardian #1 Parent/Guardian #2 Pick-Up/Daycare Address (if different than above): If Parent/Guardian(s) listed above is NOT the LEGAL guardian of this student, please provide legal guardian information below: Name Birth date MM/DD/YY Phone Relationship to student Address City/State/Zip / / Please list all other children living at the address where the student resides: What relation is Legal Last Legal First Legal Middle Gender Birth date Parent/Guardian #1 Name Name Name (M/F) (MM/DD/YY) School Grade to the child? In accordance with the Minnesota Data Practices Act, directory information (name, address, phone number, gender, date of birth) can be released and made public. Completion of this section is required In compliance with the United States Department of Education, Improving America s Schools Act (IASA, Title 1 Part C, Section 1309), we are required to ask the following question: Have you recently (within the last 36 months) moved to this school district for temporary or seasonal agricultural or fishing work? YES NO Signature (Parent/Legal Guardian) Date THIS IS A TWO-SIDED FORM

2019-20 Ethnic and Racial Demographic Designation Form Student s First Name: Middle Name/Initial: Last Name: Date of Birth: District: School: Schools are required to report ethnicity and race to the state and to the U.S. Department of Education. Because of recent changes to Minnesota state law, Minnesota disaggregates each category into detailed groups to further represent our student populations. Parents or guardians are not required to answer the federal questions (in bold) for their children. If you choose not to answer the federal questions (in bold), federal law requires schools to choose for you. This is a last resort we prefer if parents or guardians complete the form. State questions are labeled as Optional and schools will not fill in this information for you. This information helps improve teaching and learning for everyone and helps us accurately identify and advocate for students currently underserved. The information this form collects is considered private information. You can review the privacy notice to learn more about the purpose of collecting this information, how it will be used and not used, and how the detailed groups were identified. The privacy notice can be found in our Frequently Asked Questions: Ethnic and Racial Designation Form. Is the student Hispanic/Latino as defined by the federal government? The federal definition includes persons of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. 1 [You must select yes or no to this question.] o Yes [If yes, go to Question A.] o No [If no, go to Question 1.] Optional Question A: If yes was chosen above, select all that apply from the list below (this question will not be answered by school staff): Decline to indicate Colombian Ecuadorian Guatemalan Mexican Puerto Rican Salvadoran Spaniard/Spanish/ Spanish-American Other Hispanic/Latino Unknown Go to Question 1. [Select yes to at least one of the Questions (1-6) below.] Question 1: Does the student identify as American Indian or Alaska Native as defined by the state of Minnesota? The state of Minnesota definition includes persons having origins in any of the original peoples of North America who maintain cultural identification through tribal affiliation or community recognition. [This question is needed to calculate state aid/funding.] o Yes [If yes, go to Question 1a.] o No [If no, go to Question 2.] Optional Question 1a: If yes was chosen above, select all that apply from the list below (this question will not be answered by school staff): Decline to indicate Cherokee Other North American Indian Tribal Affiliation Anishinaabe/Ojibwe Dakota/Lakota Unknown Go to Question 2. 1 Federal Register, Vol. 72, No. 202/Friday, October 19, 2007/Notices/59274

Question 2. Is the student American Indian from South or Central America? o Yes [Go to Question 3.] No [Go to Question 3.] Question 3. Is the student Asian as defined by the federal government? The federal definition includes persons 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. 1 o Yes [If yes, go to Question 3a.] o No [If no, go to Question 4.] Optional Question 3a. If yes was chosen above, select all that apply from the list below (this question will not be answered by school staff): Decline to indicate Asian Indian Burmese Go to Question 4. Chinese Filipino Hmong Karen Korean Vietnamese Other Asian Unknown Question 4. Is the student black or African American as defined by the federal government? The federal definition includes persons having origins in any of the black racial groups of Africa. 1 o Yes [If yes, go to Question 4a.] o No [If no, go to Question 5.] Optional Question 4a. If yes was chosen above, select all that apply from the list below (this question will not be answered by school staff): Decline to indicate African-American Ethiopian-Oromo Ethiopian-Other Liberian Nigerian Somali Other black Unknown Go to Question 5. Question 5. Is the student Native Hawaiian or Other Pacific Islander as defined by the federal government? The federal definition includes persons having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. 1 o Yes [Go to Question 6.] o No [Go to Question 6.] Question 6. Is the student white as defined by the federal government? The federal definition includes persons having origins in any of the original peoples of Europe, the Middle East, or North Africa. 1 o Yes o No Parent(s)/Guardian Name Date Parent(s)/Guardian Signature

Minnesota Language Survey Minnesota is home to speakers of more than 100 different languages. The ability to speak and understand multiple languages is valued. The information you provide will be used by the school district to see if your student is multilingual. In Minnesota, students who are multilingual may qualify for a Multilingual Seal upon further assessment. Additionally, the information you provide will determine if your student should take an English proficiency test. Based upon the results of the test, your student may be entitled to English language development instruction. Access to instruction is required by federal and state law. As a parent or guardian, you have the right to decline English Learner instruction at any time. Every enrolling student must be provided with the Minnesota Language Survey during enrollment. Information requested on this form is important to us to be able to serve your student. Your assistance in completing the Minnesota Language Survey is greatly appreciated. Student Information Student s Full Name: (Last, First, Middle) Birthdate or Student ID: Check the phrase that best describes your student: Indicate the language(s) other than English in space provided: 1. My student first learned: language(s) other than English. English and language(s) other than English. only English. 2. My student speaks: language(s) other than English. English and language(s) other than English. only English. 3. My student understands: language(s) other than English. English and language(s) other than English. only English. 4. My student has consistent interaction in: language(s) other than English. English and language(s) other than English. only English. Language use alone does not identify your student as an English learner. If a language other than English is indicated, your student will be screened for English language proficiency. Parent/Guardian Name (printed): Parent/ Guardian Information Parent/Guardian Signature: Date: * All data on this form is private. It will only be shared with district staff who need the information to best serve your student and for legally required reporting about home language and service eligibility to the Minnesota Department of Education. At the district and at the Minnesota Department of Education, this information will not be shared with other individuals or entities, except if they are authorized by state or federal law to access the information. Compliance with this request for information is voluntary.

STUDENT TRANSPORTATION FORM (Please PRINT and complete entire form.) This form must be completed for all students attending Hilltop, Pine Bend, or Salem Hills Elementary. Student: (Legal Last Name) (Legal First Name) (Middle Initial) School: Grade: School Year: Parent: (Legal Last Name) (Legal First Name) (Middle Initial) Main Phone: Work Phone: E-mail: TRANSPORTATION INFORMATION please circle all appropriate days Start Date: Home Transportation To School: M T W Th F From School: M T W Th F No Transportation To School: M T W Th F From School: M T W Th F Daycare Transportation To School: M T W Th F From School: M T W Th F Daycare Provider: Daycare Phone: Effective Start Date: Daycare Provider Address: (Street Address) (City, State, Zip Code) I understand it is my responsibility to transport my child between home and the designated daycare address. The School Main Office must be notified of any change in this information during the current school year. A new form must be filled out prior to each school year. Parent/Guardian Signature: Date:

REQUEST TO RELEASE PRIVATE DATA (Please PRINT and complete entire form.) Date Date of Birth Student s Full Name District Last Attended School (Last attended) Address City, State, Zip Phone Fax Please circle the school that the student will attend in Inver Grove Heights Pine Bend Elementary Salem Hills Elementary/Atheneum Hilltop Elementary 9875 Inver Grove Trail 5899 Babcock Trail 3201 68 th Street E Inver Grove Heights, MN 55076 Inver Grove Heights, MN 55077 Inver Grove Heights, MN 55076 651-306-7701 651-306-7300 651-306-7400 FAX 651-306-7739 FAX 651-306-7321 FAX 651-306-7444 Inver Grove Heights Middle School Simley High School/Simley ALP 8167 Cahill Ave. 2920 80 th St. E. Inver Grove Heights, MN 55076 Inver Grove Heights, MN 55076 651-306-7200 651-306-7000 FAX 651-306-7939 FAX 651-306-7938 The information to be released: Official school records containing private data, including gender, race, discipline records, attendance records, class rank, standardized test results, and State testing information Health record Chemical abuse / dependency report Psychological reports Medical report (including related services) Special education records Psychiatric report Teacher, counselor, staff observations Social work report Pictures Other I authorize ISD 199, to release or obtain information for the student listed above. Signature of Parent / Guardian (or student age 18 or over) Date According to the Final Regulations Family Education Rights and Privacy Act (Buckley Amendment) dated June 17, 1976, it is no longer necessary to obtain written consent to release records between schools. It states that school officials, including teachers within the educational intuitional, and officials of other schools in school systems in which the student may intend to enroll, may receive a student s record without written consent for such a release.

Appendix I to Policy 624 STUDENT ELECTRONIC TECHNOLOGY USE AGREEMENT FORM By signing below, I agree to follow Inver Grove Heights Community Schools Electronic Technologies Acceptable Use Policy. I understand that my use of the district electronic technologies is a privilege and the misuse of the district electronic technologies will result in disciplinary action. Student s Name (please print): (Grades 4-12 Only) Home Address: Street Address, City, State, Zip code Home Phone: Cell Phone: School Building: I have read Policy 624 titled Electronic Technologies Acceptable Use and the Appendix II Code of Ethics. I understand or have had this information explained to me and will abide by the Inver Grove Heights Community Schools Electronic Technologies Acceptable Use Policy. Student s Signature: Date: / /20 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PARENT OR GUARDIAN (If you are under the age of 18 a parent or guardian must also read and sign this agreement.) As the parent or guardian of this student I have read and understand the Inver Grove Heights Community Schools Electronic Technologies Acceptable Use Policy. I understand that this access is designed for educational purposes. I also recognize it is impossible for Inver Grove School District to restrict access to all controversial materials and will not hold them responsible for materials acquired on electronic technologies. I hereby give permission for my student to access and use electronic technologies and certify that the information contained on this form is correct. It is the parent or guardian s responsibility to supervise students at home even while doing school assigned projects. Parent or Guardian Name (please print): Parent or Guardian Signature: Date: / /20 Appendix II to Policy 624 ADOPTED 2017-2018 13

ONLINE CODE OF ETHICS In the Inver Grove Heights Community Schools, it is important to use information and technology in safe, legal, and responsible ways. We embrace these conditions as facets of being a digital citizen and strive to help students develop a positive digital footprint. 1. Students accessing or using Web based products including but not limited to blogs, wikis, podcasts, Google applications and Moodle for student assignments are required to keep personal information out of their postings. 2. Students will select online names that are appropriate and will consider the information and images that are posted online at an age appropriate level. 3. Students will not log in to the network as another classmate. 4. Students using Web based tools will treat these tools as a classroom space. Speech that is inappropriate for class is not appropriate on Web based tools. Students are expected to treat others and their ideas online with respect. 5. Assignments on Web based tools are like any other assignment in school. Students, in the course of completing the assignment, are expected to abide by policies and procedures in the student handbook, including those policies regarding plagiarism and acceptable use of technology. 6. Student blogs are to be a forum for student expression; however, they are first and foremost a tool for learning. The district may restrict content for valid educational reasons as outlined in board policy. 7. Students will not use the Internet, in connection with the teacher assignments, to harass, discriminate, bully or threaten the safety of others. If students receive a comment on a blog or other Web based tool used in school that makes them feel uncomfortable or is not respectful, they must report this to a teacher, and must not respond to the comment. 8. Students accessing Web based tools from home or school, using school equipment, will not download or install any software without permission, and not click on ads or competitions. 9. Students should be honest, fair and courageous in gathering, interpreting and expressing information for the benefit of others. Always identify sources and test the accuracy of information from all sources. 10. Students will treat information, sources, subjects, colleagues and information consumers as people deserving of respect. Gathering and expressing information should never cause harm or threaten to be harmful to any person or group of people. 11. Students are accountable to their readers, listeners and viewers and to each other. Admit mistakes and correct them promptly. Expose unethical information and practices of others. 12. School board policies concerning acceptable use of electronic technology include the use of these Web based tools for school activities (Policy 622 Copyright Policy and Policy 634 Electronic Technologies Acceptable Use). 13. Failure to follow this code of ethics will result in behavior intervention as outlined in the Student Expectations Handbooks. Appendix III to Policy 624 ADOPTED 2017-2018 14