Community High School District #99 North High School

Community High School District #99 North High School Realizing Individual Potential for the World Community School Year 2017-2018 Dear Parent/Guardian and Student, Thank you for your interest in the enrollment and registration procedure at North High School. To begin, you must inform the current school of your intent to leave and complete their withdrawal process. It is your responsibility to request transfer records. Refer to the Enrollment Check List to assist you in gathering the necessary documents. Omission of any necessary documents will delay the enrollment process and course selection. Complete the following enclosed forms (all are required): Student Information Form Release of Records Residency Affidavit Special Needs History Information IHSA Section 3 form Upon review of the materials you have submitted, I will schedule Math and English assessment testing and an appointment for you and your student to meet with a guidance counselor. Be advised that the enrollment process may include, but may not be limited to, the following: an interview with an administrator, referrals from the previous schools, placement tests, and residency checks. Welcome to North High School! Sincerely, Ruth Schneider Registrar

COMMUNITY HIGH SCHOOL DISTRICT 99 NORTH HIGH SCHOOL ENROLLMENT CHECK LIST All documentation must be presented in acceptable form prior to making an appointment for enrollment. Any omission will delay testing appointments and course selection. DOCUMENTS REQUIRED FROM PARENT/GUARDIAN Residency Required: one from Category A and two from Category B (proof from BOTH categories) ORIGINALS MUST BE SUBMITTED. REGISTRAR WILL MAKE COPIES. Category A (one document showing a current District #99 address) Real estate tax bill Mortgage statement/closing contract Signed lease (with a contact phone number for the leasing agent) Agreement of sale If the student s family is not the owner/lessee of the District #99 address, additional forms may be obtained from the registrar and are required. Category B (two documents showing a current District #99 address) Driver s license (showing new District #99 address) Home/apartment insurance Public aid card Utility bill within the past 2 months (excluding phone or cable) Currently dated bank statement or currently dated payroll stub Other Student Documents Certified birth certificate for the student OR student passport (if birth certificate is not available) Photo ID of parent or guardian District 99 forms included in this packet Additional Documentation Specific situations may require further documentation to determine the residential custodian of the student based on care or custody agreements. Please be prepared to share such documents, if requested. DOCUMENTS FROM PREVIOUS SCHOOL It is the parent/guardian responsibility to request transfer records. REQUIRED: 1. ISBE Student in Good Standing transfer form from Illinois schools or Letter of Good Standing on school letterhead from private or out-of-state schools. (Example of letter is the last page of this packet.) 2. Unofficial transcript for current high school students. 7 th and 8 th grade report cards for incoming freshmen. 3. A State of Illinois Certificate of Child Health Examination including immunizations with the physician s signature and address. A printout of immunizations does not meet this requirement. Incoming freshmen: a physical is required before the first day of school. Out-of-state transfers: immunizations must be provided, and an Illinois physical will be required within a certain time frame. 4. Current class schedule and grades in progress if transfer is occurring during the school year. 5. Current IEP for any student receiving Special Services at their previous school. OPTIONAL: 6. Standardized test scores

IMPORTANT INFORMATION REGARDING MATH AND ENGLISH ASSESSMENT TESTING All students new to North High School are required to take Math and English assessment testing prior to the registration appointment with his or her counselor. Assessment testing will be scheduled when all necessary enrollment documents have been received by the registrar. Summer Transfers: Test appointments will be scheduled on certain dates in the summer and held from 8:30 to 10:30 a.m. Students should arrive no later than 8:20 a.m. in the main office on the day of their scheduled testing. They are allowed and encouraged to bring their own calculators, as well as pencils, for the math assessment. School Year Transfers: After summer group testing, students will need to sit for the assessments on an individual basis. Transfer documents must be submitted by 11:00 a.m. in order to schedule testing for the next day. Testing will occur daily at 8:00. Students should arrive at 7:45 a.m. in the Guidance office. Please note: there is no testing scheduled on late arrival or shortened school days. In the event that your student does not appear for his or her scheduled test appointment, the registration appointment will be forfeited and arrangements will be made to reschedule the testing and registration appointments. If the student misses his or her testing appointment, no guarantee can be made that he or she will be able to attend the first day of classes.

2017-2018 School Year STUDENT INFORMATION FORM DISTRICT 99 - NORTH CAMPUS Today s STUDENT Office Use Only ID # Counselor Dean P/S Bus School of Origin Entry Code New Student DGS DGN Reentry 09 2021 10 2020 11 2019 12 2018 Last First Middle Name Nickname Race (Choice of one or more is required) (1) Native American/Alaskan Native Birthdate / / Gender M F (2) Asian (5) White (7) Native Hawaiian/Other (3) Black/African American Pacific Islander You must choose Yes or No Hispanic/Latino Ethnicity Yes No Birthplace City State Country Last School Attended City State GUARDIAN 1 Person the student lives with: Last Name First Name Relationship to Student Address Apt E-mail address Zip Home phone Work ext Mobile GUARDIAN 2 If guardian 2 lives at different address, please note address: Last Name First Name Relationship to Student Address Apt E-mail address Zip Home phone Work ext Mobile EMERGENCY CONTACT 1 (other than parent/guardian) Last name First name Relationship to student Home phone Work Mobile EMERGENCY CONTACT 2 (other than parent/guardian) Last name First name Relationship to student Home phone Work Mobile **Please note when answering the questions below, the intent is if the language is spoken fluently as a home language.** Is a language other than English spoken at home? Yes No If yes, what language Does the student speak a language other than English? Yes No If yes, what language All of the above information is true and correct Parent/Guardian Signature

Community High School District #99 North High School 4436 Main Street Downers Grove, IL 60515-2800 (630) 795-8400 www.csd99.org RELEASE OF STUDENT RECORDS Parent/Guardian: Return this form to North High School SENDING SCHOOL PLEASE SEND TO: School Name Ruth Schneider, Registrar Community High School District 99, North High School Street 4436 Main Street City State Zip Downers Grove IL 60515 Phone Phone 630-795-8425 Fax 630-795-8199 Fax email rschneider@csd99.org Student Name of Birth I give my permission to release any or all of the information listed below to North High School for the purpose of enrollment, registration, and transfer of academic credit: A sealed official transcript. All medical and immunization records. ISBE Student Transfer Form (Illinois schools only). Grades in progress at time of withdrawal. (Please include date of withdrawal.) Cumulative file and/or standardized test results. Discipline records. Special Education records, including current IEP and most recent case study evaluation. Signature of Parent/Guardian Signature of Student (if over 18 years of age) According to the Family Educational Rights and Privacy Act, Final Rule on Educational Records, Federal Register, June 17, 1976, Vol. 41, No. 118, Page 24673, it is no longer necessary to obtain written consent to release records between schools. It states that school officials within the educational institution and officials of other schools in the school systems in which the student may intend to enroll, may receive a student s records without written consent for such release.

COMMUNITY HIGH SCHOOL DISTRICT #99 RESIDENCY AFFIDAVIT Student Last Name First Name Middle Address City Zip Phone ( ) Lives with: Parent(s) Guardian Parent(s)/Guardian(s) Name_ Do you have legal custody of the student? Yes No Previous Address City Zip Lived with Phone ( ) Where did the student reside during the previous summer? Where did the student attend school last year? Brothers and sisters: Name Age Address School Attending Legal Residency Requirements The right to attend a District #99 High School is extended to residents who live in the District Boundaries. Under the law, the student s residence is considered to be the home of his/her parent(s) or legal guardian(s). Students who move into the school district to live with relatives or friends for the purpose of attending a District #99 High School are not considered legal residents in the district and therefore cannot be admitted to the school. The District may investigate the residence of any student before or after enrollment and require the involved persons to provide additional information to be considered by the District in determining residency. Enrollment is not completed, and attendance will usually not be permitted, until all residence issues are resolved. ANY PERSON WHO KNOWINGLY ENROLLS OR ATTEMPTS TO ENROLL ON A TUITION-FREE BASIS A STUDENT WHOM THE PERSON KNOWS TO BE A NON-RESIDENT, OR WILLFULLY PRESENTS FALSE INFORMATION REGARDING THE RESIDENCY OF A PUPIL, SHALL BE GUILTY OF A CLASS C MISDEMEANOR, PUNISHABLE BY A FINE OF NOT MORE THAN $500 AND IMPRISONMENT OF NOT MORE THAN 30 DAYS. I certify that I am a legal resident of Community High School District #99. My signature below confirms all the information provided and that the form is true and correct. I understand Illinois law has made it a crime to knowingly and willfully present false information regarding residency of a student for purposes of enabling that student to attend a District #99 high school when the student is known to be a non-resident of District #99. Parent/Guardian signature below also gives permission to District #99 to contact individuals having knowledge of current residency, including but not limited to landlords, lease holders, relatives where indicated, previous schools, etc. Printed name of Parent/Guardian Signature of Parent/Guardian

Community School District 99 NORTH HIGH SCHOOL Special Needs History Information ** To be completed even if student does not have an IEP. ** Student s Name Former School Has this student ever received Special Education services/support? Yes No When and what type of program? Do you have copies of any IEPs? Yes No If student has an IEP, immediately provide a copy for the registrar. IEP is required to initiate the enrollment process. Has this student ever been accelerated or held back a grade? Yes No If yes, please explain: Is there any significant information we should know regarding the student s previous school experience? Yes No If yes, please explain:

Section 3-To be completed by the Transferring Athlete and Parent IHSA Student name 15. Please provide a short narrative of the purpose/need for the transfer of schools: 16. Please list all non-school (AAU/Club) team affiliations: (Failure to list affiliations may compromise eligibility.) Sport Team Name Coach Name (First, Last) Year Was your transfer for any of the following reasons? 17. Yes No To obtain the athletic advantage of a superior or inferior athletic team, a superior athletic facility or a superior coaching staff 18. Yes No To obtain relief from a conflict with the philosophy or action of an administrator, teacher or coach relative to athletics 19. Yes No To seek a team consistent with the student s athletic abilities 20. Yes No To nullify punitive action taken by the previous school 21. If yes to any of the above, please explain: A transfer based upon undue influence includes, but is not limited to, an offer or acceptance of any athletic award, gift, amenity, gratuity or benefit that might include money, extension of credit, meals, travel, use of vehicles, promise of athletic scholarships, promise of a rostered spot on a high school team, school privileges, or considerations not granted to other students. 22. Yes No This transfer is based upon the acceptance of promise of undue influence. 23. Yes No I certify that I have not received any of the items listed above from a receiving school representative as inducement to transfer schools and participate in athletics at the school. 24. Yes No I certify that I was not contacted or recruited by any agent of the receiving school, coach, or other representative, with the expressed intent to obtain my attendance of the receiving school. 25. Yes No Does a connection exist between any current/former club coach and a member of the high school coaching staff of the receiving school? If yes, explain: If it is discovered that information on this document was falsified, the student could be required to serve a period of ineligibility not to exceed 365 days at the time of discovery. 26. Student Signature Parent/Guardian Name Parent/Guardian Signature

PHYSICAL EXAMINATION / IMMUNIZATION REQUIREMENTS 9 th GRADE TRANSFER STUDENT REQUIREMENTS: The School Code of Illinois requires that each student entering 9 th grade have a physical examination, on the Illinois Certificate of Child Health Examination Form, completed by a licensed physician, an advanced practice nurse or physician s assistant. The physical examination must include: height, weight, blood pressure, BMI, diabetic screening, signatures and dates in order to be considered in compliance. The Health History section must be completed, signed and dated by the parent/guardian of the child. Student records must show proof of immunization series according to the guidelines of the Illinois Department of Public Health; Diphtheria, Pertussis, Tetanus, Tdap, Polio, Measles (Rubeola), Mumps, Rubella, Hepatitis B, Varicella and Meningitis. The State of Illinois does periodically update vaccination requirements for school age students. New requirements will be communicated on the school website. 10th -12th GRADE TRANSFER STUDENTS: Students transferring from an Illinois school must present a copy of their ninth grade school physical examination and a complete immunization record at the time of enrollment. Students transferring from another state or country must present current immunization records and physical examination at the time of enrollment. An Illinois physical will be required within a certain time frame. Students transferring to an Illinois public school for the first time are required to have a vision examination conducted by a physician or licensed optometrist. Any child entering the 12 th grade shall show proof of having received two doses of meningococcal conjugate vaccine prior to entering the 12 th grade. The first dose shall have been received on or after the 11 th birthday, and the second dose shall have been received on or after the 16 th birthday, at least eight weeks after the first dose. If the first dose is administered when the child is 16 years of age or older, only one dose is required. Students entering 12 th grade will be excluded on the first day of school, and every day thereafter, until documentation of the required meningococcal vaccination has been received and approved by Health Services. ATHLETIC PARTICIPATION: If your child will be participating in any of the Athletics programs, the physical examination must be completed AFTER JUNE 15 th to ensure participation for the full school year. For freshmen only, the 9 th grade physical on the State of Illinois form is valid for thirteen months toward athletic participation. The IHSA sports physical form is not acceptable for 9 th grade entrance. Only a physical examination completed on the State of Illinois Certificate of Child Health Examination form is acceptable for 9 th grade entrance. HEALTH CONCERNS: If your child has specific health concerns, please note these concerns on the Illinois Certificate of Child Health Examination form. Contact the school nurse at the beginning of the school year to coordinate care and plan for potential emergency response. Please remember to update emergency contact information as needed throughout the school year. MEDICATION POLICY: Community High School District 99 acknowledges that the responsibility for administering medication to a student rests primarily with the student s parent or guardian. Medication will be administered by district personnel during the school day only when absolutely necessary for the health and well-being of the student. The initial dose of the medication must be given at home. If medication is necessary, it must be brought to the school in the original container labeled by the pharmacist (or manufacturer of over the counter medications). All medications, including over the counter medications, must be accompanied by the district s medication authorization form completed and signed by both the parent and the physician; each medication must be on a separate form. Medication authorization forms are available in Health Services Office, website or on the school web page at www.csd99.org. It is important to note that students are prohibited from carrying medications or keeping medications in their lockers. Only students authorized to selfadminister asthma medication or rescue epinephrine are permitted to carry medications on their person. The State of Illinois Health Examination form can be found on North High s website under Student Support Services, on the Nurse & Health Services page, and the form is also available at the front desk in the main office. Questions or concerns regarding the above policies may be directed to the Health Services Office at North High School (630-795-8480).

45-386 Kaneohe Bay Drive Kaneohe, Hawaii 96744 June 10, 2017 From: Castle High School Kaneohe, HI To: Registrar Downers Grove North High School Re: Kalani Kumaka DOB: 11/23/2003 I verify that Kalani Kumaka was enrolled as a full-time student during the attendance dates shown below and left our school in good standing. The student is not under any suspension or expulsion. of entry: August 26, 2016 of withdrawal: June 8, 2017 Sally Secretary Name Signature Registrar June 23, 2017 Position