Enrollment Forms Packet (EFP) Please review the information below. Based on your student(s) grade and applicable circumstances, you are required to submit documentation in order to complete this step in the enrollment process. You can fax, scan and email, or mail the required paperwork. Important Note: Please send copies, do not mail in original documents. Required For? Item Description Provided by? Required for all Students Proof of Age Official Birth Certificate (not the hospital issued certificate) Proof of Residency Arizona Residency Documentation Form Release of Records PHLOTE McKinney-Vento Eligibility Questionnaire AZ state issued Driver s License (only accepted if the address is not a P.O. Box) OR current Utility bill showing service address OR Mortgage statement including signature page OR Lease Agreement including the landlord s signature Please complete this form and submit. By filling out this form, you are giving our school permission to request your student s official records from their previous school after the approval process. If your child is enrolling in Kindergarten or was Homeschooled please indicate it on the form, fill out the top portion and sign it. This is the Primary Home Language Other Than English Home Language Survey. Please answer the question and sign the form. Please make sure that you answer all 4 of the questions and sign the form Arizona Virtual Academy/Insight Academy of Arizona Enrollment Processing Center 2300 Corporate Park Dr. Suite 200 Herndon, VA 20171 Ph. 866.467.6183 Fx. 866.989.0713 www.k12.com/azva Fax (preferred): Scan and Email: Mail: 1-866-989-0713 azvafax@k12.com Arizona Virtual Academy/Insight Academy of Arizona Enrollment Processing Center 2300 Corporate Park Drive Suite 200 Herndon, VA 20171 Withdrawal Slip Withdraw slip from your last school of attendance to indicate that you are no longer attending. Please Note: this should be the final document you submit Required for all rising 1st - 9th Grade Students Required for all rising 10th -12th Grade Students 11-12 Standardized Test Results A copy of your student s Stanford 10 or AIMS results is required for all 3-12th graders if not included in your students transcript or report card. Report Card Student s most recent Report Card Unofficial Transcripts You will need to request an unofficial transcript from your student s current school, which will show your student s academic standing. This is required in order to place all 10th - 12th graders. Once your student is approved, we will receive the official transcript. Required for student with an IEP or other Special Education needs IEP Evaluation Report A copy of your student s current IEP (Individualized Education Plan). Because the IEP expires yearly, please submit the current IEP. The Evaluation Report is valid for 3 years. If you do not have a copy of your student s ER, you can request a copy from your student s current school. Required for students that have a 504 plan 504 Accommodation Plan A copy of your student s current 504 Accommodation Plan. Because the 504 expires yearly, please submit the current 504.
Arizona Virtual Academy/Insight Academy of Arizona Enrollment Processing Center 2300 Corporate Park Dr. Suite 200 Herndon, VA 20171 Release of Student Records Ph. 866.467.6183 Fx. 866.989.0713 www.k12.com/azva Please accept this document as formal approval for the release of all official school records (including the record of transcripts, testing information, special education, health and immunization records). Student Information Student s Full Name: Student s Date of Birth: first middle last Student s Legal Address: street apt # city county state zip Home Phone: Alternate Phone: Homeschooled or Never Previously Enrolled in School (Fill out only if applicable Check below if applicable: o Student was always previously homeschooled o Student is enrolling in Kindergarten Prior School Information Name of Prior School: School s Address: street city county state zip School s Phone: School s Fax: Name of Parent or Legal Guardian: first last Parent/Guardian s Signature: Date: SCHOOL OFFICIALS ONLY: Send student records to: Mail to: Arizona Virtual Academy/Insight Academy of Arizona 99 E. Virginia Ave, Suite 200 Phoenix, AZ 85004 Or fax to 602-595-6874 Student s Name: Student s Home Phone: 9
Office Use Only Computer: Yes No FRL status: Free Reduced Contact Attempt 1: / / Note: Contact Attempt 2: / / Note: MV Eligible: Yes No McKinney-Vento Eligibility Questionnaire Name of Student: _ First Middle Last Phone: Birth Date: _ Grade: Male Female Include Area Code Month/Day/Year Name of Parent / Guardian / Caregiver / Host / Self: Circle Relationship First Last Address: _ Street Address City State Zip This questionnaire is intended to address the McKinney-Vento Act 42 U.S.C. 11435. The answers to this residency information help determine the services the student may be eligible to receive. Eligibility must be reviewed and reevaluated every school year. Signature of Parent/Legal Guardian: _ Date: _ Permanent Housing: Is this student living in a housing situation that is -- Ex: family home, apartment- leasing, rental residence, own property / guaranteed bed at night / home occupancy is appropriate-- fixed (stationary/not subject to change) Yes No regular (used on a nightly basis) Yes No adequate (meets physical and psychological needs typically met in home environments) Yes No If you answered NO to ANY of the above, please complete the remainder of this form. If you answered YES to ALL of the above, please stop here. You are done with this form. Send in with the remainder of your enrollment documentation. Thank you! ==================================================================================== Temporary Housing: If this student is NOT residing in a fixed, regular, and adequate nighttime situation, where is the student presently living? (Check at least one box). Is this student currently living with a parent or legal guardian? In a Motel / Hotel Temporarily with another family in their home due to a lack of adequate alternatives (sometimes referred to as doubled-up ) In a place not designated for ordinary sleeping accommodations such as a car, park, bus, train or campsite Awaiting foster care placement Other temporary living situation (Please describe):_ How long has the student lived in the above residence? _ Is current living situation due to a hardship? Yes No If yes, please explain: _ Is the student currently living in a Shelter or Transitional Housing Program Yes No Do you work in agriculture and/ or does your residence depend on seasonal work? Yes No School Personnel: If the Temporary Housing portion of this form has been filled out, please fax a copy to the AZVA McKinney-Vento Liaison FAX: 602-595-6874
State of Arizona Department of Education Office of English Language Acquisition Services PHLOTE -Primary Home Language Other Than English Home Language Survey (Effective April 4, 2011) These questions are in compliance with Arizona Administrative Code, R7-2-306 (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 I.D. Date of Birth SAIS I.D. Parent/Guardian Signature Date 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. 1535 West Jefferson, Phoenix, Arizona 85007 602-542-0753 www.azed.gov/oelas
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 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 *For members of the armed services, the provision of verifiable documentation does not serve as a declaration of official residency for income tax or other legal purposes. #2803440
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 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: State of Arizona County of Acknowledgement The foregoing was acknowledged before me this _ day of, 20_, By. _ Notary Public My Commission Expires: #2803440