GUIDELINES FOR REGISTRATION AND ENROLLMENT OF STUDENTS DISTRICT SCHOOL BOARD OF COLLIER COUNTY

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1 GUIDELINES FOR REGISTRATION AND ENROLLMENT OF STUDENTS DISTRICT SCHOOL BOARD OF COLLIER COUNTY Dr. Kamela Patton Superintendent of Schools

2 Dr. Kamela Patton Superintendent of Schools THE DISTRICT SCHOOL BOARD OF COLLIER COUNTY Roy M. Terry, Chair Barbara Berry, Vice Chair Patricia M. Carroll, Member Kathleen Curatolo, Member Julie Sprague, Member This report has been prepared by The District School Board of Collier County. Additional copies, if available, may be obtained by writing: The District School Board of Collier County Dr. Martin Luther King, Jr. Administrative Center Student Services 5775 Osceola Trail Naples, Florida Report Number: Coordinated by: Mrs. Christy Kutz No person in this district shall, on the basis of race, national origin, sex, disability, marital status, religion, or age, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity, or in employment conditions or practices conducted by The District School Board of Collier County. VISION STATEMENT All students will complete school prepared for ongoing learning as well as community and global responsibilities. For questions or complaints (adults) regarding the Educational Equity Act, Title IX, Section 504 (Rehabilitation Act), or the Americans with Disabilities Act, contact Debbie Terry, Executive Director of Human Resources, (239) For questions or complaints (students) regarding the Educational Equity Act, Title IX, or The Age Discrimination Act of 1975, contact Dr. Diedra Landrum, Coordinator of Student Services/Guidance & Counseling, (239) For questions or complaints (students) regarding Section 504 (Rehabilitation Act) and the Americans with Disabilities Act, contact Dr. L. Van Hylemon, Coordinator of Psychological Services (239) The address for the above contacts is: The District School Board of Collier County, 5775 Osceola Trail, Naples, Florida

3 GUIDELINES FOR REGISTRATION AND ENROLLMENT OF STUDENTS Mrs. Christy Kutz Director of Student Services

4 1. Enrollment Requirements TABLE OF CONTENTS Part I: New Student Registration PK-12 Proof of Residency...2 School Health Requirements...4 Social Security Information...6 Proof of Age...7 Kindergarten...7 First Grade...8 High School: Regular Students, Students over age 16 or Emancipated Minors...9 Homeless Students...10 Students with Expulsions and Arrests...11 Temporary Enrollment of Student for Testing Purposes Only Enrollment Part II: Transfer Students Students Entering from another School In-County...12 Students from Out-of-County, Out-of-State or Out-of-Country Withdrawal Students Transferring In-County...12 Students Transferring Out-of-County or Out-of-State...12 High School Students Withdrawing with a Dropout Withdrawal Code...13 Procedures for Checking Students Out of School during the School Day...13 Part III: Students from Foreign Countries 4. VISA s, I-20 s and Foreign Exchange Students...14 Part IV: Appendix Appendix A Student Enrollment form...16 Appendix B Annual Student Emergency Information Card...22 Appendix C Statement of Acceptance of Liability and Responsibility for School Age Children Form...28 Appendix D Sworn Statement Verifying Birthdate...31 Appendix E Certificate of Age (physician's affidavit)...32 Appendix F Policy Maximum Age for Participation in the Regular High School Program...33 Appendix G Declaration of Intent to Terminate School Enrollment...34 Appendix H Memo: Registration and Enrollment Power of Attorney...37 Appendix I High School Exit Interview

5 Part I: New Student Registration PK-12 This booklet has been developed in order to standardize enrollment procedures throughout the Collier County Public Schools. Additional information on enrollment should be directed to the Department of Student Services at All children who have attained the age of 6 years or who will have attained the age of 6 years by February 1 of any school year or who are older than 6 years of age but who have not attained the age of 16 years, except as otherwise provided, are required to attend school regularly during the entire school term. Florida Statute s (1) (a) Additionally, a child who attains the age of 16 during the school year is not subject to compulsory school attendance beyond the date upon which he or she attains that age, if the child files a formal declaration of intent to terminate school enrollment with the District School Board. The student must meet with the Principal or designee for an exit interview before submitting an intent to terminate school enrollment. The declaration must acknowledge that terminating school enrollment is likely to reduce the student s earning potential and must be signed by the child. The school district must notify the child s parent or legal guardian of the child s declaration of intent to terminate school enrollment. (See Appendix G) Enrollment To enroll a child in Collier County Public Schools, a parent or guardian must complete: Student Registration form (Appendix A), and Annual Student Emergency Information Card (Appendix B) at the school site. The parent/guardian must also provide the school with the required documentation for residency (1+2 proofs), health requirements (immunization certificate, physical examination), and proof of age (see pages 2-6). The complete name, address, ZIP code, and phone number of any school the student previously attended, along with the last report card or withdrawal form must be provided. If divorced, a copy of the decree and any current legal documents that apply to the parents rights as they relate to the child at school (such as restraining order or school pick-up) must be provided to the school. To ensure that school staff may identify and locate students from the TERMS database, school staff must enter student information in TERMS on panel S313 and a class enrollment on S614 as soon as possible. Proof of Residency The District will request information regarding residency to determine the location of the student s domicile but not as it relates to citizenship or immigration status. 2

6 The place of residence for the child is deemed to be that place, with address specific, where the parent(s) or guardian eats and sleeps on a continuous basis. A student and his parents cannot occupy a residence at more than one address. Parents or guardians may prove residency by providing ONE of the following: Homestead Exemption Card reflecting Homestead Exemption within Collier County(considered family s primary residence) Property Tax Notice (may require additional verification) Home Purchase Contract in Collier County specified closing date, with a copy of the deed to be provided within 60 days of closing date Copy of a Manifestation of Domicile filed by the parent (obtained at the Collier County Courthouse/The Clerk of Courts Office) A current rental or lease agreement AND TWO of the following: A current Florida driver license or Florida Identification Card Automobile Insurance (last two statements) A current electric billing statement, bottom portion showing name and service address Water bill or Cable bill or Landline Phone Bill (last two statements) (*New residents may provide set up of service for 2 utilities with name and address for enrollment. Within 60 days must provide first 2 months bills to school) 1. If a parent would like their child to attend a school other than their home zoned school they must submit a request to the Choice and Out of Zone Specialist (form is available on the district website). Out of zone attendance must also be approved before the student s enrollment is completed. 2. Parents who live with someone else must provide: Notarized letter from person they are living with stating that the parent and child live there. Notarized confirmation from parent(s) that they (he/she), in fact, live with such person. 3 Proofs of address from person who wrote the letter to establish that they live in the school zone. 3 Proofs of address from the parent to verify that they live at the address. 3. Parents whose child lives with someone else (see Appendix H) must provide: Notarized Power of Attorney that includes the following information must be submitted to the Department of Student Services by the school or parent for review prior to enrollment. o Relationship of guardian to child o States that guardian will be responsible for the child s educational needs. o Length of temporary guardianship 3

7 Department of Student Services will notify the school regarding status of enrollment. If Student Services approves enrollment of the child by the guardian: o Guardian must sign district Statement of Acceptance of Responsibility Form. (Appendix C) o Parent or guardian must provide evidence of pursuit of legal custody through the courts to the school within 90 days (school will note on TERMS S313 Screen). o Student Services will follow-up with district letter to parent/guardian and school, as needed. 4. Homeless student information is available by contacting the Homeless Liaison at Should a student move, proof of residency must be provided as stated above. The following items are evidence a move is full and complete: a. The former residence is not occupied for any purpose as any time by the student or any of the persons with whom the student has been living; and b. All personal belongings are moved from the former residence: and c. Mail is received at the new residence; and d. All utilities are transferred to the new residence; and e. Driver license, voter registration and other forms of legal identification are changed to the new residence. Notice Students whose parents are found, after appropriate investigation, to have submitted fraudulent information in an effort to enroll a student in a school to which the student is not assigned shall be immediately withdrawn and referred for enrollment in the appropriate boundaried school. School Health Requirements Certification of a physical examination and current immunizations is required. Students must produce a DH 680 Form on white or blue paper which is the only document schools accept as proof of immunization. Private Physicians and the Health Department can provide this form. An electronic DH 680 on white paper is valid if it conatins an electronic signature, the Florida State seal is imbedded in the background, the Florida Shots logo is in the bottom right corner, and a unique identifier number is located under the provider name. The Religious Examption from Immunizations form (DH 681) is only granted by county health departments. No Student may attend school without proper documentation of immunization or exemption. Florida Statue requires that all students entering Florida schools for the first time 4

8 present a certificate of physical examination performed within twelve (12) months prior to enrollment. Immunizations Florida Statute requires that all students entering Florida schools must present proper documentation of immunization or exemption. No child may attend school without proper documentation of immunization or exemption. No exemption period is permitted while waiting for transfer of records (A homeless child, as defined in F.S , shall be given a temporary exemption for up to 30 school days. An exemption for up to 30 days may also be issued for a student who enters a juvenile justice program to permit the student to attend class until his or her records or the actual immunization can be obtained.) The public school nurse or authorized private school official is responsible for follow up of each such student until proper documentation or the actual immunizations are obtained. Only the standard Florida Department of Health Certificate of Immunization is acceptable. This may be obtained from a private physician or the County Health Department. Parents must obtain the standard approved Florida Department of Health forms before a student may be enrolled. The Collier County Health Department provides required immunizations free of charge. Electronically transferred records (FASTER) containing a student s completed immunization information are acceptable forms of documentation for students transferring from one Florida school district to another. A copy of the actual paper certificate must be forwarded for the student record. School nurses may download completed Florida Certificates of Immunization from Florida Shots. Schools must refuse admittance to and temporarily exclude any child otherwise entitled to admittance to kindergarten, or any other entrance into a Florida public or private school, who is not in compliance with the provisions of the law regarding immunization against communicable disease. A student must be excluded from school until they can provide proof of immunization against communicable disease or a certificate of exemption. Students whose parents do not present a new certificate after expiration of a temporary certificate must also be excluded from school. It is strongly recommended that a tickler file system be developed in schools to help track students with temporary immunization certificates for students who are homeless or in Department of Juvenile Justice facilities. Any child whose parent or guardian presents a Religious Exemption from Immunizations Form may be granted exemption from the immunization requirement. This Religious Exemption from Immunization Form is only issued by the County Health Department. Physical Examinations Florida Statute requires that all students entering Florida Schools for the first time present a certificate of physical examination performed within twelve (12) months prior to enrollment. The Florida DH 3040 form is recommended to document a physical examination however any record may be used that includes at minimum all the elements contained in the form DH

9 Although this is a one-time requirement for grades PK-12, upon first time entry into any Florida school, students who have previously attended any public or private school in Florida must have documentation of a physical exam. A child may be exempted from the requirement for a physical examination upon written request of the parent or guardian stating objection to such examination on religious grounds. The Collier County Health Department does not provide pre-entrance school physicals. Students new to Florida, who do not have health insurance or other means to obtain a physical, may be referred to the Ronald McDonald Caremobile for a free school-entry physical. Students who are scheduled for a physical on the CareMobile may be admitted to school. Social Security Information As a result of increased attention and concern regarding identity theft, the District School Board would like to clarify the procedures for obtaining a student s social security number. Florida Statute requires school districts to request a social security number for each student in grades PreK Adult who enroll in school. However, a student is not required to provide his or her social security number as a condition for enrollment or graduation. Refusal to provide a social security number will not be documented in the student s file. The student s identity may be verified by one of the following documents: Original copy of the Social Security Card (if available). Bank statements, insurance records or other similar documents that periodically require verification and contain the student s social security number. A signed statement, by the parent, either submitted separately or included as part of another district form that attests to the authenticity of the student s social security number. If a student does not provide a social security number, the school district should assign a number using the common method statewide. First Two Digits For any student entering a Florida school district for the first time who does not have a social security number, the first two digits will represent the district of initial entry into the Florida school system. Last Eight Digits The last eight digits are district-defined in such a way as to result in a unique student number within the district where the number is originally assigned. If a student does not provide a social security number at the time of entry, but later provides a social security number, the district must update the Student Identification Number with a verified social security number. School staff must not make copies of alien cards, social security cards, licenses, or passports from students or their parents when registering students. Parents may be asked 6

10 to complete the social security information on the registration form, but they are not required to do so. In order to be in compliance with the META Consent Decree for ESOL students, there will be no photocopies of the student s and/or parent s social security cards, alien cards, licenses, passports or similar documentation anywhere in the student s cumulative file. No personally identifiable data of any kind shall be elicited, compiled or maintained as to any individual student s immigration status. Other papers that happened to contain the student s social security number on them, such as test results and reports that are in the student s cumulative file, are not a concern. Proof of Age Per Florida statute, any student entering PK-12 shall show an original or certified copy of a birth certificate or other proof of age. The following are acceptable documents for evidence of date of birth: Birth Certificate; (original or certified copy of birth certificate) A certificate of baptism showing the date of birth and place of baptism of the child, accompanied by an affidavit sworn to by the parents (Appendix D); An insurance policy on the child s life which has been in force for at least two years; bona fide contemporary Bible record of the child s birth accompaniedby an affidavit sworn to by the parent (Appendix D); A passport or certificate of arrival in the United States stating the age of the child; A transcript or record of age shown in the child s school record of at least four years prior to application, stating date of birth. An affidavit of age sworn to by the parent accompanied by a certificate of age signed by a public health officer or private physician indicating that the physician has examined the child and believes that the age as stated in the affidavit is substantially correct. (Appendices, D, E) A homeless child, as defined in s shall be given temporary exemption from this section for 30 school days. Notice The principal will refer cases of suspected document fraud (original birth certificate, official transcript) to the Youth Relations Deputy from the Collier County Sheriff s Office assigned to the school. 7

11 Kindergarten Florida Statute requires that a child be five (5) years old on or before September 1, 2007 in order to enroll in public kindergarten. (See Proof of Age). Only one exception is made to the age requirement for entrance into kindergarten. The exception involves kindergarten students transferring from another state. Such transfer students may be admitted regardless of age, if two criteria are met: The transfer student must meet the entrance age requirements of the public schools of the state from which he/she is transferring. The parents or legal guardians of the child must have been legal residents of the state from which the child is transferring. First Grade Florida Statute requires satisfactory completion of kindergarten, in order for a child to be eligible to enter first grade. A child who has satisfactorily completed either public or private kindergarten may be admitted to first grade if he/she will be six years old on or before September 1. All students entering first grade other than those transferring from Florida public schools must provide documentation of birth date. (See Proof of Age.) Children who have attended a private kindergarten may be admitted to first grade only upon presentation of a letter from the director of the private kindergarten indicating that the child has satisfactorily completed a kindergarten skill developmental program. An exception may be made regarding age requirements for first grade entrants. Students transferring from another state may be admitted to first grade, if the following three criteria are met: The child has successfully completed kindergarten in the state from which he/she is transferring. The child meets the entrance age requirements of the public schools of the state from which he/she is transferring. The parent or legal guardian of the child was a legal resident of the state from which the child is transferring. Florida Statute (1) (a) requires that any child who has attained the age of six years or who will attain the age of six years by February 1st, of the current year, attend school regularly throughout the school year. Before admitting a child to the first grade who has attended a private kindergarten in Florida, the principal shall require evidence of date of birth as required by law. (See kindergarten enrollment procedures for acceptable proof of age.) Students not meeting age requirements but who have satisfactorily completed the requirements for kindergarten in a private school from which the district school board accepts transfer in a manner similar to that applicable to other grades, shall progress according to the district s student progression plan. 8

12 High School: Regular Students, Students Over the Age of 16, or Emancipated Minors All high school transfer students must have an official transcript from the last school that they attended. An official transcript is a document that is sent directly from the administrator of the school where the credit is earned to the receiving school administrator. An unofficial transcript is one that is hand delivered by the student or parent, or is delivered to the designated school administrator in an open envelope, or on plain paper. For transfer students ages 16 or older, an official transcript from the last school attended must be received and reviewed by the school counselor prior to enrollment if there has been a significant gap of a semester or more in their high school enrollment history. For transfer students age 16 or older without a gap of a semester or more in their high school enrollment history, an official transcript from the last school attended must be received no later than the end of the first complete term after the enrollment of the student. If it is not received, the student will be withdrawn and referred to Adult Education subject to legal review. Students must be able to meet the graduation requirements by the school year of their 21 st birthday (22 for ESE).Students who can t meet the graduation requirements or who have significant gaps in their high school enrollment history may be referred to Adult Education. A student between the ages of sixteen (16) and twenty-one (21) may not enroll or withdraw themselves from general education without parental permission or guidance, unless they are an emancipated minor (as evidenced by legal documents). Per Florida Statute s a student who attains the age of 16 years is not subject to compulsory school attendance beyond the date upon which he or she attains that age, if the child files a formal declaration of intent to terminate school enrollment with the District School Board (See Appendix G). The student must meet with the Principal or designee for an exit interview before submitting an intent to terminate school enrollment. The declaration must acknowledge that terminating school enrollment is likely to reduce the student s earning potential and must be signed by the child. The school district must notify the child s parent or legal guardian of the child s declaration of intent to terminate school enrollment. Per School Board policy (Appendix F), in order to provide reasonable consistency of maturity levels among students in the regular high school program, no person shall be permitted to attend the regular high school program beyond the school year during which they attain the age of twenty-one (21). Persons who are eighteen (18) years old or older and who, by earning eight (8) credits per academic year, cannot meet regular education graduation requirements, including grade point average (GPA), prior to the end of the school year during which they attain the age of twenty-one (21), shall not be permitted to register, enroll, or attend the regular high school program beyond the end of the academic year in which they attain the age of eighteen (18). Such persons shall be afforded an opportunity to 9

13 pursue a high school diploma through the Adult High School or General Educational Development (GED) programs of the Collier County Public Schools. The provisions of this policy limiting enrollment of students between the ages of eighteen (18) and twenty-one (21) years shall not be automatically applied to students served by the district s Exceptional Student Education Programs for students with disabilities. The provisions of this policy may, however, serve as guidelines for Staffing/IEP Committees as the educational needs of students with disabilities are individually considered. The district will provide services to students with disabilities until the end of the semester in which they turn twenty-two (22). In order to protect the safety and welfare of younger students, principals may refuse enrollment in the regular high school education program to those persons who have had a history of disruptive behavior in the school setting, who have attained the age of eighteen (18) years, and who have previously dropped out of the regular high school program; and refer them to Adult Education. Such persons shall be afforded the opportunity to pursue a high school diploma through the Adult High School or General Educational Development (GED) programs of the Collier County Public Schools. The provisions of this paragraph shall not apply to students who are classified as Exceptional students. High School Head of Guidance will review the academic standing of students 18 years old and older prior to and at the conclusion of Term 1, as well as, students without official transcripts. Homeless Students (Policy ) The McKinney-Vento Act defines homeless children and youth as individuals who lack a fixed, regular and adequate nighttime residence [Section 725(2)]. This includes: 1. Children and youth who are: a. sharing the housing of other persons due to loss of housing, economic hardship, or a similar reason (sometimes referred to as doubled up ); b. living in motels, hotels, trailer parks, or camping grounds due to the lack of alternative adequate accommodations; c. living in emergency or transitional shelters d. abandoned in hospitals; e. awaiting foster care placement. 2. Children and youths who have a primary nighttime residence that is a public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings. 3. Children and youth who are living in cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations, or similar settings. 4. Migratory children who qualify as homeless for the purposes of this because the children are living in circumstances described above. 10

14 Also included are: 1. Homeless preschoolers. 2. Homeless unaccompanied youth, which includes youth who are not in the physical custody of a parent or guardian [Section 725 (6)]. This would include youth living in runaway shelters, abandoned buildings, cars, on the streets, or in other inadequate housing; youth denied housing by their families (sometimes referred to as throwaway youth); and school-age unwed mothers, living in homes for unwed mothers, who have no other housing available. If a youth s living situation does not clearly fall into the situations described above, the LEA should refer to the McKinney-Vento definition of fixed, regular, and adequate nighttime residence and consider the relative permanence of the living arrangements. The Act [Section 722(g)(3)(C) and(e), Public Law ] requires enrolling schools to: 1. Immediately enroll the homeless student, even if the student is unable to produce records normally required for enrollment such as previous academic records, medical records, proof of residency, or other documentation. 2. Immediately contact the prior school the student attended to obtain relevant academic and other records. 3. Immediately refer the parent or guardian of the student or the unaccompanied youth to the local homeless liaison to assist in obtaining necessary immunizations, or medical and immunization records, if needed. 4. Provide a written explanation of its decision and the right to appeal if a student is sent to a school other than an eligible one requested by a parent or guardian or the unaccompanied youth. Students with Expulsions and Arrests Disclosure at time of registration Chapter of the Florida law requires that any student seeking admission to a public school in the State of Florida be required to provide information regarding expulsions, arrests which may have resulted in a formal charge, or any involvement with the Juvenile Justice System. This information is requested at the time of initial registration and indicated on the registration form. Temporary Enrollment of Student for Testing Purposes Only Contact Exceptional Student Education (ESE) Department at for procedures. 11

15 Part II: Transfer Students Enrollment Students Entering from another School In-County Require the student to present a completed Withdrawal Form from the releasing school. The school may telephone the releasing school to determine if the student has properly withdrawn. If the student has not properly withdrawn, he/she should return to the releasing school to be properly withdrawn. (This applies more to secondary students than to elementary.) Request the student's cumulative folder from the releasing school. Students entering from the Home Education Program must complete and return an Intent to Withdraw from Home Education form to the Department of Student Services. Students Entering from Out-of-County, Out-of-State or Out-of-Country Require the student to present a completed Withdrawal Form from the releasing school. The school may telephone the releasing school to determine if the student has properly withdrawn. High School students MUST provide an official transcript from previous school. Request the student's cumulative folder from the releasing school. Students Transferring In-County Withdrawal Issue a copy of the completed standard Withdrawal Form for each student to hand carry to the receiving school. When requested by the receiving school, forward the student's cumulative folder directly to that school. Do not forward the student's cumulative folder until it is requested by the receiving school. When entire classes of students are promoted to another school within Collier County at the end of the school year, the principal of each transferring school or his designee shall personally transport a list of the students names and their respective cumulative folders to the appropriate receiving schools. A receipt for the cumulative folders from the receiving school should be obtained. Students Transferring Out-of-County or Out-of-State It is recommended that a copy of the immunization certificate and school physical examination be given to parents of children transferring from Collier County Public Schools to another school system. This will help to facilitate the child's enrollment in the new system. Issue the standard Withdrawal Form when the parent notifies the school that the 12

16 student is leaving or transferring to another school. The transfer of student records shall be made immediately upon request by the parent or receiving school. All reasonable effort shall be made to collect fines, but under no circumstances shall the transfer of a student's records be delayed or denied for failure to pay a fine or fee assessed by the school. High School Students Withdrawing from School with a Dropout Withdrawal Code If a secondary student has dropped out of school, he/she should be referred to the school counselor so that an Exit Interview (see Appendix I) and the Declaration of Intent to Terminate School Enrollment Form can be completed by the student and copied to the parent. (See Appendix G) Exit Interview forms should be placed with the students educational records. Note: W05 W15 Code is for any student age 16 or older who leaves school voluntarily with no intention of returning. A student may only be withdrawn from school due to nonattendance after all in sections and , Florida Statutes, have been followed. Procedures for Checking Students Out of School during the School Day 1. When enrolling children in school, parents indicate contact information on the district enrollment form. The contact information section of the enrollment form includes the name(s) of parent/guardian, other, and emergency contact (name/relationship), home and work telephone numbers for each person listed and whether each person is authorized to pick up the student, and whether each person has have legal custody of the child. This contact information is entered by the school on the TERMS screen panel S At the beginning of each school year, an emergency contact form is sent home with students for parents to provide current emergency contact information, which is updated in TERMS. 3. Students leaving school during the school day must be signed out by an adult through the office. a. The adult must be authorized to pick the student up from school according to the contact information recorded in TERMS. b. Identification must be provided by the adult. c. If an emergency situation requires a parent to send a person to pick up their child who is not listed in the emergency contact information, the school must receive permission in a form satisfactory to the principal from the parent to authorize this pick up. The adult signs the student out of school by signing the log sheet maintained by the school. 13

17 Part III: Students from Foreign Countries VISA s, I-20 s and Foreign Exchange Students The District School Board of Collier County does not issue I-20 forms. Moreover, students who possess F-1 (academic) or M-1 (vocational) visas are not eligible for enrollment since they have received such status through other educational institutions or programs. Per Homeland Security s.214.2(7) Enrollment in a course of study prohibited An alien who is admitted as, or changes status to, a B-1 or B-2 non-immigrant status on or after April 12, 2002, or who files a request to extend the period of authorized stay in B-1 or B- 2 non-immigrant status on or after such date, violates the conditions of his or her B-1 or B-2 status if the alien enrolls in a course of study. Per district procedures 5114 Foreign Exchange Students Foreign exchange program students, who possess J-1 visas, are eligible for enrollment for the duration of stay permitted by the visa or other United States Department of Regulations upon proof of approval by the appropriate sponsoring authority. Foreign exchange program students must: A. have sufficient knowledge of the English language to participate in high school classes; B. submit a transcript in English of the secondary school work prior to enrollment; C. have provided appropriate insurance coverage; D. be accepted by a host family in the zone of attendance; E. obtain prior written approval of the principal. The host family will contact the guidance office at the home zoned high school to initiate the registration process. The following information must be provided: A. Proof of residency the host family must provide three (3) proofs that they reside in the school zone. B. Immunization the host family will obtain a Florida Immunization Certificate by taking the student s immunization record to the Collier County Department of Health. C. Physical the host family will provide evidence of a physical exam within the twelve (12) months prior to starting school by obtaining a school physical form. D. Student passport and J-1 Visa. All foreign exchange students must be enrolled and participating in a full course of study and a full day schedule; and comply with all District rules and regulations. Note: Foreign exchange program students who have received a high school diploma from another country are not eligible to enroll in the District. Note: Foreign exchange program students enrolled in the District are not eligible to receive a high school diploma. Any credits earned will be transferred back to the student s home country. However, class rings and yearbooks may be purchased on the same terms as they are by other students. 14

18 Part IV: Appendix 15

19 STUDENT ENROLLMENT Name of staff completing form Date completed THIS AREA FOR OFFICE USE ONLY SCHOOL NAME CCPS STUDENT # ENTRY DATE GRADE TEACHER NAME FLORIDA ID # Birth Verification (1-9) Health Exam Valid Immunization Certificate Valid Out-of-Zone Yes No Bus # Previous school records requested DIRECTIONS: Parent/Guardian please complete all areas and check appropriate boxes, sign and date Student's Legal Name: Also known as (alias): Last First Middle Residence Address Apt# Mailing Address (if different than residence address) Apt # City State Zip City State Zip Has your child attended a United States school for less than 3 full years? Yes No If yes, date entered in U.S. MM/DD/YY / / Is your child a member of an active military family? Yes No Is your child Hispanic or Latino? Yes No Sex: Male Female Date of Birth: MM/DD/YY / / What is your child s race? (mark all that apply) American Indian or Alaska Native Asian Black or African-American Native Hawaiian or Pacific Islander White Is a language other than English used in the home? Yes No If yes, what language? (Hm) Did the student have a first language other than English? Yes No If yes, what language? (Pl) Does the student most frequently speak a language other than English? Yes No If yes, what language? (Sl) Place of Birth: City: State: Country of birth if other than U.S.: STUDENT Social Security # (optional): In which language do you prefer to be contacted either in writing or by phone? (Cl) English Spanish Haitian/Creole Does student live with parent? Yes No If yes and parents are not married: custody documentation restraining order If no: name of guardian relationship to student power of attorney provided Statement of Acceptance of Responsibility form provided Is student in foster care placement? Yes No If yes, name of guardian Is your family residing in any of the following situations? Sharing the housing of others due to loss of housing or economic hardship (Code B) Living in a motel or hotel due to loss of housing or economic hardship (Code E) Staying in a shelter Immokalee Friendship House St. Matthew s House Providence House (Code A) Substandard house; without electricity, running water, health code violations, lack of cooking capabilities, etc. (Code D) Sleeping in a car, campground, park or public space (Code D) 16

20 CONTACT INFORMATION PARENT/GUARDIAN NAME (Please include address if different from student) Mother/Guardian: Father/Guardian: Other (Name/Relationship): Emergency Contact (Name/Relationship): Has student ever attended a Collier County public school? Yes No Home Phone Work Phone Cell Phone Authorized Pickup Yes No Yes No Yes No Yes No Has student attended a Florida public school? Yes No Last School/Preschool Attended Name Withdrawal Date / / Address City State Zip Phone # Legal Custody Yes No Yes No Yes No Yes No Was your child in any Exceptional Education program at his/her previous school, i.e., Speech, SLD, Gifted, EBD, etc.? Yes No Was your child in an ELL program at his/her previous school? Yes No Has your child ever been arrested resulting in a charge or juvenile justice action? Yes No If Yes, please direct parent to School Counselor At this time, is your child under an expulsion or alternative placement order? Yes No If yes, please identify where (what school) and when (what dates) I certify that the above enrollment information is true and accurate to the best of my knowledge. Printed Name of Parent/Guardian Signature Relationship Date THE COLLIER COUNTY PUBLIC SCHOOL SYSTEM IS AN EQUAL ACCESS / EQUAL OPPORTUNITY INSTITUTION FOR EDUCATION AND EMPLOYMENT revised 03/01/

21 INSCRIPCION DEL ESTUDIANTName of staff completing form Date completed ESTA AREA ES SOLAMENTE PARA EL USO DE LA ADMINISTRACION SCHOOL NAME CCPS STUDENT # ENTRY DATE GRADE TEACHER NAME FLORIDA ID # Birth Verification (1-9) Health Exam Valid Immunization Certificate Valid Out-of-Zone Yes No Bus # Previous school records requested INSTRUCIONES: Padre/Encargado favor de completar todas las áreas, chequear las casillas apropiadas, firmar y poner la fecha Nombre Legal del Estudiante: También conocido como (alias): Apellido Primer Nombre Segundo Nombre Dirección de la Residencia #de Apto. Dirección Postal (si es diferente de la dirección residencial) # Apto Cuidad Estado Código Postal Cuidad Estado Código Postal Ha estado su hijo asistiendo a una escuela en los Estados Unidos por menos de tres años completos? Sí No De ser sí, indique su fecha de entrada al país. / / Es su hijo miembro de una familia militar activa? Sí No Es su hijo hispano o Latino? Sí No Sexo: Masculino Femenino Fecha de Nacimiento: Mes/Día/Año / / Cual es la raza de su hijo? (marque los que sean aplicables) Indígena de las Américas o de Alaska Asiática Negra o Africana-Americana Indígena de Hawái o de las Islas del Pacífico Blanca Se habla en el hogar un idioma que no sea el inglés? Sí No De ser sí, qué idioma? (Hm) Inicialmente, habló el estudiante un idioma que no era el inglés? Sí No De ser sí, qué idioma? (Pl) El idioma que el estudiante habla con más frecuencia es otro que no sea el inglés? Sí No De ser sí, que idioma? (Sl) Lugar de Nacimiento: Cuidad: Estado: País de Nacimiento si no es Estados Unidos: # de Seguro Social del ESTUDIANTE (opcional): En qué idioma desea usted ser contactado sea por escrito o por teléfono? (Cl) Inglés Español Criollo Haitiano Vive el estudiante con algún padre? Sí No De ser sí, y los padres no están casados: Orden Judicial de Custodia de Menores Orden de Protección/Restricción De ser no: nombre del encargado parentesco con el estudiante Carta Poder provista Formulario de Declaración de Aceptación de Responsabilidad provisto Está el estudiante viviendo en un hogar adoptivo provisional (foster care)? Sí No De ser sí, nombre del tutor legal Vive su familia en alguna de las siguientes situaciones? Compartiendo la vivienda de otros a causa de perdida de alojamiento o dificultades económicas (Code B) Viviendo en un motel u hotel a causa de pérdida de alojamiento o dificultades económicas (Code E) Alojamiento en un refugio Immokalee Friendship House St. Matthew s House Providence House (Code A) Vivienda inadecuada; sin electricidad, sin agua, con infracciones del código de salud, sin cocina, etc. (Code D) Durmiendo dentro de un automóvil, en un campamento, parque o lugar público (Code D) 18

22 INFORMACION DE CONTACTO NOMBRE DEL PADRE/ENCARGADO (Favor de incluir la dirección si es diferente a la del estudiante) Madre/Encargado: Correo Electronico Padre/Encargado: Correo Electronico Otro (Nombre/Parentesco): Contacto en caso de emergencia (Nombre/Parentesco): Asistió alguna vez a una escuela pública del Condado de Collier? Sí No Teléfono Tel. Trabajo Tel. Celular Autorizado para recoger Sí No Sí No Sí No Sí No Asistió alguna vez a una escuela de la Florida? Sí No La última escuela/pre-escolar que asistió Nombre Fecha de Salida / / Dirección Cuidad Estado Código Postal #Teléfono Custodia Legal Sí No Sí No Sí No Sí No Estuvo su hijo en algún programa de Educación Excepcional en la escuela anterior, es decir, clase del habla, SLD, Dotado, EBD, etc.? Sí No Estuvo su hijo en un programa de ELL en la escuela anterior? Sí No Ha sido su hijo alguna vez arrestado resultando en una acusación o Acción de Justicia Juvenil? Sí No If (Sí) Yes, please direct parent to School Counselor Está su hijo/a en estos momentos bajo una orden de expulsión o de ubicación alterna? Sí No De ser sí, favor de explicar dónde (qué escuela) y cuándo (fecha) Yo certifico que toda la información de inscripción más arriba descrita es verdadera y exacta según mi entender. Nombre del Padre/Encargado (letra de molde) Firma Parentesco Fecha EL SISTEMA DE LAS ESCUELAS PÚBLICAS DEL CONDADO DE COLLIER ES UNA INSTITUCION CON IGUALDAD DE ACCESO Y OPORTUNIDADES PARA LA EDUCACION Y EL EMPLEO revised 04/30/

23 FEY ENSKRIPSYON ELEV YO Non manb pèsonèl ki konplete fòm sa a Dat fòm nan konplete SEKSYON SA A SE POU OFISYEL YO SELMAN NON LEKOL LA CCPS STUDENT # ENTRY DATE GRADE TEACHER NAME FLORIDA ID # Birth Verification (1-9) Health Exam Valid Immunization Certificate Valid Out-of-Zone Yes No Bus # Previous school records requested DIREKSYON: Paran/Responsab souple konplete tout pati nan fèy la epi tcheke kazye apwopriye yo, siyen epi mete dat. Non Legal Elèv la: Epi yo konnen li sou non (alias): Siyati Non Non Mitan Adrès kote li Rezide # Apt Adrès li Resevwa Lèt (Si li diferan de adrès kote li rete a) # Apt Vil Eta Kòd Postal Vil Eta Kòd Postal Eske pitit ou a te frekante yon lekòl nan peyi Etazini pandan mwens pase 3 ane an plen? Wi Non Si wi, bay li te antre nan peyi Etazini. MM/DD/YY / / Eske pitit ou a se manb yon fanmi ki aktif nan sèvis militè? Wi Non Eske pitit ou a se Ispanik oubyen Latino? Wi Non Sèks: Mal Femèl Dat Nesans: MM/DD/YY / / Se nan ki ras pitit ou a soti? (make tout sa ki aplike pou li) Endyen Ameriken Endyen oubyen Natif Alaska Azyatik Nwa oubyen Afriken-Ameriken Natif Hawaii oubyen Zile Pasifik Blan Èske yo pale yon lòt lang ki pa Anglè lakay la? Wi Non Si wi, se ki lang? (Hm) Èske elèv la te pale yon premye lang ki pa Anglè? Wi Non Si wi, se ki lang? (Pl) Èske elèv la pale yon lòt lang ki pa Anglè pi souvan? Wi Non Si wi, se ki lang? (Sl) Kote li fèt: Vil: Eta: Peyi kote li fèt si se pa Ozetazini: # Sekirite Sosyal ELEV LA (opsyonèl): Nan ki lang ou prefere nou kontakte ou ke se swa pa ekri oubyen nan telefòn? (Cl) Anglè Espanyòl Kreyòl 20

24 ENFÒMASYON POU KONTAK NON PARAN/RESPONSAB LA (Tanpri enkli adrès ou si li diferan de pa elèv la) Manman/Responsab: Papa/Responsab: Lòt Moun (Non/Relasyon): Kontak Dijans (Non/Relasyon): Eske elèv la te janm ale nan yon lekòl piblik Collier County? Wi Non Telefòn Lakay Telefòn Travay Telefòn Pòtab Otorize pou vin Pran li Wi Non Wi Non Wi Non Wi Non Eske elèv la te ale nan yon lekòl piblik nan Florida? Wi Non Dènye Lekòl/Pre-eskolè li te Frekante Non Dat li Soti / / Adrès Vil Eta Kòd Postal # Telefòn Gadyen Legal Wi Non Wi Non Wi Non Wi Non Eske pitit ou a te patisipe nan nenpòt pwogram Edikasyon Eksepsyonèl nan lekòl avan li yo, i.e., Pale, SLD, Don, EBD, etc.? Wi Non Eske pitit ou a te nan yon pwogram ELL nan lekòl li te frekante avan yo? Wi Non Eske yo te arete pitit ou a akoz yon aksyon an jistis jivenil ki t ap peze kont li? Wi Non Si Wi, tanpri transfere paran an bay Konseye Lekòl la Nan moman nou ye la a, èske pitit ou a sou zòd pou yo mete li deyò lekòl la oubyen pou yo voye li nan plasman altènatif? Wi Non Si wi, tanpri idantifye ki kote (ki lekòl) ak kilè (ki dat) Mwen sètifye ke enfòmasyon sou enskripsyon ki pi wo a vrè e ekzak dapre sa mwen konnen. Enprime Non Parant/Responsab la Siyati Relasyon Dat SISTEM LEKOL PIBLIK COLLIER COUNTY SE ENSTITISYON KI BAY AKSE EGAL / OPOTINIT EGAL POU EDIKASYON AK TRAVAY revize 04/30/

25 Annual Student Emergency Information Card for School Year This card must be completed by parent/guardian and signed each school year Please notify the school if any of the following information changes during the year School: Teacher: Student ID #: Grade: Name of Reviewing School Nurse: Date Reviewed: Actions: Parent/Guardian- Please complete all areas below (print), Check appropriate boxes, sign, date, and return. Student's Legal Name: Last First Middle Also known as (alias): Last First Middle Is your child covered by: Private health insurance Medicaid Sex Male Female Date of Birth: Month/Day/Year / / Healthy Kids/Kid Care No insurance Does student live with parent? Yes No If no, name/relationship of guardian: Student s home phone: Court-ordered custody document provided? Yes No Court ordered restraint order? Yes No Student s Home Address: Apt# Student s Mailing Address (if different than home address) Apt # City State Zip City State Zip Is this a new address? Yes No Contact and Emergency Information (Attach additional page if necessary) Parent/Guardian Name (Please include address if different from student) Mother/Guardian Name Address (If different) Father/Guardian Name Address (If different) Home Phone Work Phone Cell phone or Pager Authorized Pickup Yes No Yes No Other (Name/Relationship Address (If different) Yes No If parent/guardian cannot be reached please notify the person(s) below in case of an emergency. Emergency Contact (Name/Relationship) Yes No Legal Custody Yes No Yes No Yes No Yes No Emergency Contact (Name/Relationship) Please provide names of other children attending Collier County Public Schools: Yes No Current District School Attending: Yes No PLEASE COMPLETE IMPORTANT INFORMATION ON REVERSE SIDE 22

26 Name of Child s Physician: Annual Student Emergency Information Card for School Year This card must be completed by parent/guardian and signed each school year Please notify the school if any of the following information changes during the year Student Health and Medical Information Phone Number: Name of Child s Dentist: Phone Number: Does your child have any health conditions that school staff members should be aware of? No Yes If yes, please briefly describe the condition and any assistance needed: Does your child have any activity restrictions? No Yes If yes, please explain: Does your child have any allergies? No Yes - If yes, list Does the allergy require life saving medications? No Yes - What are the medications? Describe symptoms and treatment(s): Has a doctor told you your child has asthma? No Yes If yes, when was he/she diagnosed? Is medication for the asthma required at school? No Yes If yes, name of medication(s): Does your child require medication at school on a regular basis? No Yes If yes, specify (A completed and signed Medication Authorization form must be submitted to the school before medication may be administered.) Privacy Statement: The District School Board of Collier County (CCPS) provides for first aid and emergency response to illness and injury in public schools and provides health services to student in public schools in partnership with: Collier County Health Department (CCHD), NCH Healthcare System, Inc. (NCH), and the Ronald McDonald Care Mobile. The partners are required by law to maintain the privacy of your child s protected health information. The District s Notice of Privacy Practices describes how your child s protected health information may be used, how the information is kept private and confidential, and explains the legal duties and practices relating to the protected health information. This Notice of Privacy Practices is available to you upon your request and is available at your child s school. By signing this document, I understand and agree that information contained on this card may be shared with appropriate school staff and health care professionals according to the Health Insurance Portability and Accountability Act (HIPAA) on a need-to-know basis for the health and safety of my child. Parent/Guardian Consent: By my signature below I accept responsibility to notify my child s school of any changes of my home or business addresses and phone numbers in case of an emergency. I understand that EMS (911) will be called when there is an emergency requiring evaluation and/or transport of my child for medical treatment and I will assume responsibility for payment for EMS services. In case of an accident or illness for which immediate emergency treatment is not needed, but my child is unable to remain in school, I request that the school contact the parent(s)/guardian(s) named above. If unable to reach a parent or guardian, I request that one of the emergency contact person(s) listed on this card be contacted to pick up and/or care for my child until I can be reached. I also authorize Collier County School District, its designated employees, volunteers, and contracted agents, representatives, and personnel to provide health services, state mandated health screening and when necessary emergency care for my child and to exchange medical information as necessary to support the continuity of care for my child. If I do not want my child to receive these services, I will notify the school in writing of the specific services that are being declined. Furthermore, if my child is covered by Medicaid and receives health services under an IEP, I consent for the school district to bill Medicaid for those services provided. By signing this document, I certify that all the above emergency, health and medical information is true and accurate to the best of my knowledge. I also understand and agree that if I have identified that my child has a health or medical condition that may require some kind of assistance or management while he/she is in school, it is my responsibility to contact the school principal and/or school nurse; make them aware of the health or medical condition(s); and discuss a possible plan of care at school. Print Name of Parent/Guardian Signature Relationship Date PLEASE COMPLETE IMPORTANT INFORMATION ON REVERSE SIDE 23