New Student Enrollment

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Hugo Acosta Flores
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1 New Student Enrollment Enrollment Packet Includes: Registration Form Occupational Survey Home Language Survey Transportation Form Parents/Guardian will need to bring: 1. Child s Birth Certificate 2. TN DEPT of HEALTH CERTIFICATION IMMUNIZATION 3. Verification of Address; MUST be a CURRENT utility bill with your name and address on it (Example: Water, Electric, Gas). The Murfreesboro City School System does not discriminate on the basis of race, sex, color, religion, national origin, age, disability, or Veteran status in the provision of services, in programs, or activities, or employment opportunities and benefits.

2 STUDENT REGISTRATION CARD (USE INK PEN ONLY) MURFREESBORO CITY SCHOOLS SCHOOL YEAR 20 - Student: Grade: Last (Full) First Name Middle Home Address: Apt # Zip If Apartment, Name of Apartment Complex In City Limits? Y N Home Phone Birthdate: Student Social Security # Birth Country: Mother s Maiden Name: Birth State: Birth County: (Circle One) Ethnicity: Non-Hispanic Hispanic (Circle One) Sex: M F (Circle All That Apply) Race: White Black Asian American Indian/Alaskan Native Native Hawaiian/Pacific Islander School Last Attended: Address: State: Zip: Fax number: Mother s Name: Address (if different from student) Place of Work: Work Phone: Cell Phone: Bus Rider: Yes No Walker: Yes No Bus Number: AM PM Extended School Program: Yes No AM PM Custody: (Circle One) Mother and Father Father and Stepmother Mother Only Mother and Stepfather Father Only Joint Custody Foster Care Other: Complete if applicable: Guardian s Name Father s Name: Address (if different from student) Place of Work: Work Phone: Cell Phone: Step Parent: Work / Cell Numbers: Please list (if any) brothers/sisters attending this school or brothers/sisters preschool ages (3-5): Name: grade/age Name: grade/age Name: grade/age In case of Illness or Injury, and parents cannot be reached call: Name: Phone Number: Special Health Problems: List all Persons Including Parents to Whom this Student MAY be Released: List anyone to whom this student MAY NOT be released: (Legal Documentation Required) Free Textbook Agreement: I will be responsible for all free textbooks/library books used by my child and will reimburse the Murfreesboro City Board of Education for the value of any book(s) damaged, destroyed, or misplaced by my child. Initials: Blanket Permission: I agree that my child s picture/name may be used in the newspaper/other media in conjunction with programs or activities related to my child s school. It is the responsibility of parents/guardian to update any information provided above. Parent/Guardian Signature: Date of Enrollment: FOR OFFICE USE ONLY: Zoned School: Address Verification: Source Document By: County App Number Custody Papers on File if applicable: Teacher assignment:

3 ENGLISH Migrant Education Program Occupational Survey STATE OF TENNESSEE DEPARTMENT OF EDUCATION BILL HASLAM 6 th FLOOR, ANDREW JOHNSON TOWER KEVIN HUFFMAN GOVERNOR 710 JAMES ROBERTSON PARKWAY COMMISSIONER NASHVILLE, TN Student Information: Last Name First Name Gender Race District School: Grade Year Migrant students may be eligible for additional services and assistance. Please answer the following questions and return the survey to the school so that we can determine if your child qualifies for migrant services. 1. Did you or someone in your family come to Tennessee looking for temporary or seasonal work in agriculture, fishing, dairy, or in any plant processing foods (examples: working with tobacco, tomatoes, cotton, strawberries, nurseries, trees, pork, chickens, vegetables, etc)? YES NO If yes, please mark which member of the family does or did this kind of work: Mother Father Children Other 2. Do you or someone in your family currently work in agriculture fishing, dairy, or in any plant processing foods (examples: working with tobacco tomatoes, cotton, strawberries, nurseries, trees, pork, chicken, vegetables, etc). YES NO If yes, please mark which member of the family does this kind of work: Mother Father Children Other 3. If your current job is not temporary work in agriculture or fishing, did you or someone in your family work in a temporary or seasonal agriculture of fishing in the last 3 years? YES NO If yes, where? City State Country If you answered yes to any of the questions above, please answer questions 4, 5 and How long have you been in this county? months years 5. What is your current address? 6. What is your current telephone number? NOTE TO THE LEA: PLEASE RETURN ONLY SURVEYS WITH ONE OR MORE YES RESPONSES TO JESSICA CASTANEDA 4660 HILLS CREEK ROAD, MCMINNVILLE TN CALL IF YOU HAVE QUESTIONS. TN form #ED-5438

4 SPANISH STATE OF TENNESSEE DEPARTMENT OF EDUCATION BILL HASLAM 6 th FLOOR, ANDREW JOHNSON TOWER KEVIN HUFFMAN GOVERNOR 710 JAMES ROBERTSON PARKWAY COMMISSIONER NASHVILLE, TN Programa de Educación para Estudiantes Migrantes Encuesta Ocupacional Nombre del Estudiante: Nombre Apellido Sexo Raza Distrito: Escuela Grado Aňo El Programa de Educación para estudiantes migrantes a través del Departamento de Educación Pública del Estado provee servicios de apoyo a los niños y familias que se han mudado Tennessee en los últimos 3 años. Para calificar en el programa las familias deben de haberse mudado de un lugar a otro en busca de trabajo temporal en agricultura o pesca. El Programa registra a niños y jóvenes entre las edades de 3 a 21 años (asistan o no a la escuela). Agradecemos que nos ayuden a determinar si su niňo o pariente califica para recibir servicios en este programa. Por favor, conteste las siguientes preguntar y entréguelas a la escuela. 1. Vino usted o alguien en su familia a buscar trabajo temporal en agricultura o en el campo (ejemplo: tabaco, papas, algodón, fresas, viveros, trabajo con árboles, etc.), o de pesca (empacadora de pescados o mariscos) o alguna planta procesadora de alimentos (cerdos, pollos, vegetales, etc.)? SI NO Si su contestación es si por favor indique que miembro de su familia hizo esta clase de trabajo. Madre Padre Hijos Otros 2. Ud. o alguien de su familia trabaja ahora en agricultura (ejemplos : tabaco, papas, algodón, fresas, viveros, trabajo con árboles, etc. ) o en una procesadora de pescado, lechería, o procesando comida (puerco, pollo, vegetales, etc.) SI NO Si su contestación es si por favor indique que miembro de su familia trabaja en esta clase de trabajo. Madre Padre Hijos Otros 3. Si su trabajo actual no se relaciona a la agricultura y pesca, Usted o algún miembro de su familia ha trabajado en dichas actividades en los últimos 3 aňos? SI NO Dónde? Ciudad Estado País Si usted contestó "sí" a alguna de las preguntas anteriores, favor de contestar las preguntas 4, 5 y Hace cuánto tiempo se mudó a este condado? Mes Año 5. Cuál es su dirección actual? Ciudad Código Postal Teléfono 6. Cuál es su numero del teléfono actual? NOTE TO THE LEA: PLEASE RETURN ONLY SURVEYS WITH ONE OR MORE YES RESPONSES TO JESSICA CASTANEDA 4660 HILLS CREEK ROAD, MCMINNVILLE TN CALL IF YOU HAVE QUESTIONS. TN form # ED-5438-S

5 Murfreesboro City School District HOME LANGUAGE SURVEY Student Name: Birth Date: Sex: Male Female Parent/Guardian Name: Address: Home Telephone: Work Telephone: School: Grade: Date: 1. What is the first language your child learned to speak? 2. What language does your child speak most often outside of school? 3. What language do people usually speak in your child s home? Murfreesboro City School District ENCUESTA DE IDIOMA DOMESTICO Nombre del alumno: Fecha de nacimiento: Sexo: Masculino Femenino Nombre de los padres/apoderado: Dirección: Teléfono de la casa: Teléfono del trabajo: Escuela: Grado: Fecha: 1. Que es la primera lengua que su nino aprendió hablar? 2. Que lengua habla su nino mas a menudo afuera de la escuela? 3. Que lengua hablan la gente generalmente en la casa de su ninos? Office Use Only Student ID# Date Distributed Date Received TN Home Language Survey

6 Murfreesboro City Schools Transportation Request Form Parent/Guardian as soon as your child(ren) has been added to a bus route the driver will contact you with the bus number and pick-up and/or drop-off times. If your child is in kindergarten or has an IEP, a parent or guardian must be at the bus stop every morning and afternoon. If no adult is at the bus stop in the afternoon, your child will be taken back to his/her school. After your child has been returned to school 5 times bus transportation could be suspended. Date: Current School: New School: Child(ren) Name: Grade: Parent/Guardian Name: Complete Address: Phone #: Cell #: Work #: Will your child(ren) ride in the: Morning Afternoon Both The following person/people have my permission to pick-up my child/children at the bus stop in the afternoon and I understand that this person must have a picture identification to show the driver; otherwise my child will be taken back to school: Please keep your list at a maximum of 4 or less. Name Relation to Child The following person/people may not pick-up my child at the bus stop in the afternoon: (If any person listed below is a legal parent or guardian of the child(ren), a legal document such as a court order or order of protection indicating that the individual is not authorized to have contact with the child(ren) must be on file with the school.): Name Instructions in case this person does try to pick-up your child/children Print Parent/Guardian Name Sign Parent/Guardian Name School Office Use Only: New Bus Student(s) Change of Address Student(s) Withdrawal Transportation Office Use Only: AM Bus Number: PM Bus Number:

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