STATE PRESCHOOL REGISTRATION REQUIREMENTS

Transcripción

1 STATE PRESCHOOL REGISTRATION REQUIREMENTS PLACEMENT GUIDELINES Placement into a class is based on your eligibility ranking, according to income and family size, established by the State of California; Placement is NOT on a first come, first served basis First priority is given to Protective Service Children and At-Risk Children Second priority is given to those children whose birthdays are between January 1 and September 1 Priority of your child s enrollment can change at any time depending on your eligibility and the eligibility of other families If your application is accepted and an opening is available, you will be contacted by phone or to schedule an appointment to complete the Registration and Enrollment Paperwork If your application is not accepted after review, you will be notified by mail REQUIRED DOCUMENTS YOU MUST BRING ONE (1) COPY OF ALL OF THE FOLLOWING DOCUMENTS TO YOUR PRESCHOOL REGISTRATION APPOINTMENT Please Note: We cannot complete your child s registration, if you are missing any of the required documents 1. Birth Certificates of ALL children (under 18) living in the home 2. Proof of Income For one month from each working parent who is responsible for the welfare needs for the family a) If Salaried Worker: The most recent check stubs within the last 30 days to the present b) If Self-Employed: Current year Income Tax Return-Form 1040 and Schedule C Profit or Loss from Business form, Signed & d Profit and Loss Statement, and/or Self-Certification of Income form Part A (Please contact our office to determine which documents will be required) c) If Paid Cash: Each parent must complete Self-Certification of Income form Part A, if you have no paystubs or receipts of employment d) If Not Working: Each non-working parent must complete the Self-Certification of Income form Part B e) If Receiving Social Services Assistance (Cash Grant): Bring a current Notice of Action received within the last 30 days. f) If Receiving Unemployment Benefits: The most recent check stubs within the last 30 days to the present g) If Seasonal Worker/Construction Worker: Check stubs of last 12 months income & Self-Certification of Income form Part A h) If Receiving Social Security or Disability Benefits: Latest Notice of Award received or copies of checks for the last four weeks i) If Foster Parent: Copy of Foster Parent Agreement indicating amount paid monthly for the preschool child and any siblings living in the home j) Child and/or Spousal Support: Provide support verification, including if former spouse pays for any other household bills (mortgage, car payments) 3. Proof of Address from Parent(s) Living With The Child A copy of the most recent PG & E bill for your residence to show that you are the responsible party in the care & welfare needs of the preschool child & siblings. If you do not have a PG&E bill, but live with someone who owns the house, the homeowner must complete the Self Declaration Under Penalty of Perjury form stating they are not responsible for the care & welfare needs of preschooler s family & to be signed by the Homeowner with a copy of the recent homeowner s PG&E bill/rental or Lease Documents. 4. Preschool Child s Immunization Record Immunizations must be current (see the back page for the list of immunizations needed) with a TB skin test & reading given after August 1 st of last year, also with a chicken pox vaccine (Varicella) or have the doctor s written documentation on the child s immunization card if child had the chicken pox disease with date and year indicated 5. Physical Examination Must have been given after August 1 st of last year. Have your child s doctor provide you with a copy of the physical report or have the doctor complete the attached Physician s Report form 6. Medical Information Including the medical insurance policy number and the doctor and dentist contact information 7. Social Security Numbers for Parent(s) and Preschool Child FOR CHILDREN LIVING WITH GUARDIAN OR FOSTER PARENTS: 8. Caregiver Affidavit If child s caretaker is a Foster Child and/or Guardianship Foster Parent s Agreement (SOC 156) and/or court order Appointing guardian of Minor & Certified Home Agreement must be submitted and processed in the Student Support Services Department at Central Unified School District Office, 5652 W. Gettysburg Ave, Room 13. Please call ext , for any questions regarding the Caregiver Affidavit. If you have any questions regarding the above required documents, please contact the Preschool Office 5652 W. Gettysburg Ave, Room 10 Fresno, CA (559) , Ext State PS-Reg Req 12/14

2 CALIFORNIA IMMUNIZATION REQUIREMENTS FOR PRESCHOOL ENROLLMENT Your child must have the immunizations listed below to attend Preschool. The child s Immunization Record must be provided at the Registration Appointment as proof of immunization. Vaccines Polio DTP/DPaP/DT/Td MMR (Measles, Mumps, Rubella) Hib Meningitis Hepatitis B Varicella Tuberculosis Skin Test (PPD) Required Dose(s) To Attend Preschool 3 doses After age 4 if last one given before 2 nd birthday, will need the 4 th dose 4 doses After age 4 if last one given before 2 nd birthday, will need the 5 th dose 1 dose Must be given on or after the 1 st birthday - **After age 4, will need 2 nd dose 1 dose Last dose must be given on or after the 1 st birthday If no dose given, one dose required until 4 ½ yrs. old 3 doses (3 dose series) 1 dose Must be given on or after the 1 st birthday or Health Care Provider must document if child has had chickenpox and shot will not be required 1 dose Must be given within one year of entry into school (after August 1 st of last year & before August of this year Please Note: If your child has not received the Tuberculosis Skin Test (PPD) after August 1 st of last year, then your child will need to have the test done prior to your Preschool Registration Appointment. If your child needs any of the required immunizations and you do not have private insurance, you may contact Fresno County Department of Health 1221 Fulton Mall - First Floor Phone: General Information Parent or legal guardian must be present Bring your child s immunization card or shot record Bring Medi-Cal Card Immunizations will be given on a first-come, first served basis Walk Ins - Monday and Wednesday from 8:00 am to 11:00am and 1:00 pm to 3:00 pm (Closed 12:00 to 1:00 for lunch) Cost Medi-Cal Free $17.55 Per Shot $8.08 Per TB Skin Test FOR TB SKIN TESTS (PPD) ONLY You may call the School Nurse at any school site listed below to schedule an appointment School Sites Phone Numbers Herndon-Barstow Elementary School El Capitan Middle School River Bluff Elementary School Central East High School , Extension 133 Imm Req 1/15

3 STATE PRESCHOOL - SELF-DECLARATION OF ABSENT PARENT I certify that I, recently separated from my spouse or child s father/mother. Parent s/guardian s Name I understand that I have six (6) months from today s date to provide the necessary documents (listed below) as proof of the separation. Documentation Needed: 1. Records of divorce or legal separation. 2. Court-ordered child custody arrangements. 3. Evidence that the parent signing the application is receiving child support payments from that person, has filed for child support with the appropriate local agency, or has executed documents with that agency declining to file for child support. 4. Rental receipts or agreements, contracts, utility bills or other documents for the residence of the family indicating that the parent is the responsible party: OR 5. Any other documentation, excluding a self-declaration to confirm the absence of a parent of a child in the family. I hereby declare or affirm, under penalty of perjury, that all the above information is true and correct; that I could and would so testify under oath, if called to do so, before any tribunal or officer empowered by the laws of this state to administer oaths. I understand that false or inaccurate information will result in my child dropped from this school. PLEASE NOTE: Perjury is punishable by imprisonment in the state prison for two, three or four years -PC section 126 Signature of Parent/Guardian Student s Name For Office Use Only Today s : Documentation Due : PREESCOLAR ESTATAL - AUTO DECLARACIÓN DEL PADRE AUSENTE Certifico que, yo recientemente separado(a) de mi esposa(o) o padre/madre de mi niño. Nombre del Padre/Guardián Comprendo que tengo seis (6) meses a partir de la fecha de hoy, para proveer los documentos necesarios (enlistados abajo) como prueba de la separación. Documentación Necesaria: 1. Récords de divorcio o separación legal; 2. Arreglos de custodia, ordenados por la corte; 3. Evidencia de que el padre que firma la solicitud está recibiendo pagos de manutención de menores de esa persona, ha aplicado para pedir ayuda (monetaria) para el niño, con la agencia local apropiada o ha llenado documentos con dicha agencia local, declinando llenar los documentos para recibir manutención de menores. 4. Recibos de renta o acuerdos, contratos, pagos de servicios (luz etc.) u otros documentos de la residencia de la familia indicando que el padre es la persona responsable; O 5. Cualquier otra documentación, excluyendo un auto declaración para confirmar la ausencia de un padre de un niño en la familia. Por este medio declare o afirmo bajo pena de perjurio que toda la información de arriba es verdadera y correcta, que puedo y testificaría bajo juramento, si soy llamado a hacerlo ante un tribunal u oficial autorizado por las leyes de este estado para administrar estos juramentos. Comprendo que proporcionar información falsa o incorrecta resultará en que mi hijo(s) sea expulsado de la escuela. POR FAVOR NOTE: El Perjurio es penado con cárcel en una prisión estatal por dos, tres o cuatro años - PC sección 126 Firma del Padre/Guardián Fecha Nombre del Estudiante Para Uso De La Oficina Today s : Documentation Due : Self Declaration 11/14

4 Declaration Under Penalty of Perjury (Declaration of Residency) I am not responsible for the care and welfare Name of Owner of Home for and her/his child(ren) Name(s) of Preschooler s Parent(s) List Name(s) of Child(ren) who live with me at. Street Address City Zip Code NOTE: Must bring current PG&E bill with the same name as listed above of owner of home and address with this form. I declare under penalty of perjury that the above information is true and correct to the best of my knowledge. Signature Declaración Bajo Pena de Perjurio (Declaración de Residencia) Yo no soy responsable del cuidado y el Nombre de Propietario de la Casa bienestar de y los niño(s) Nombre(s) de los Padre(s) del Niño que vive con migo Nombre(s) de los Niño(s) en. Dirección de la Casa Ciudad Código Postal NOTA: Debe traer cuenta de la luz (PG&E) con el mismo nombre como listó arriba de propietario de la casa y la dirección con esta forma Declaro bajo pena de perjurio que la información anterior es verdadera y correcta a lo mejor de mi conocimiento. Firma Fecha Declaration Under Perjury 11/14

5 Central Unified School District - State Preschool 4605 N. Polk Avenue, Room 10 Fresno, CA (559) Ext Fax: (559) EMPLOYMENT VERIFICATION (To be completed by Employer in the event a check stub cannot be attained) Name of Employee: Name of Employer: Address: Phone: Supervisor: Federal Tax I.D. # State Tax I.D. # of Hire: Hours of Employment: Start: End: Days of Employment: Sun. Mon. Tues. Wed. Thur. Fri. Sat. If you are working a flexible schedule, please list: Minimum Hours Per Week: Maximum Hours Per Week: Salary Information: Gross Monthly Salary: $ or Hourly Rate: $ Comments: The above information to the employee s eligibility for child care benefits and is subject to review by the State of California representatives. I affirm that, to the best of my knowledge, the above information is true and correct. By my signature, I hereby authorize my employer to release (to Central Unified School District - State Preschool) the information requested. Parent s/guardian s Signature Employer s Representative s Signature For Office Use Only Student s Name: Employment Verification 11/14

6 Central Unified School District State Preschool SELF-CERTIFICATION OF INCOME Parent s Printed Name: Student s Name: A. Self-certification of employment income for the following reason: 1. The agency has requested that I complete this form because my employer has refused or failed to provide requested employment information. 2. I have asked that my employer not be contacted to verify my employment because that contact could put my employment at risk. 3. I have no paystubs, receipts, or other documentation of employment. Employer Type of work of hire Rate of pay How often paid List the amount of income Work hours per day Days worked per week Description of work and pay for the past month B. Self-certification of non-employment income when no documentation is possible: What type of income are you receiving? List the amount of income How often do you get paid? If you are not working, list the reason why I swear, under penalty of perjury, that the above information is true and correct to the best of my knowledge. Parent/Legal Guardian Signature Self-Cert of Income 11/14

7 PARENT VOLUNTEER/CHAPERONE INFORMATION If you would like to volunteer in your child s preschool classroom and/or be a Chaperone on a Study Trip, you will need to submit the following documents: A completed Volunteer/Chaperone Application A copy of your ID Proof of a TB skin test after August 1 st of last year o If the TB skin test is positive, a chest x-ray is required and you must submit written proof (one time only) Parents volunteering twice a week or more must be fingerprinted at the Human Resources Department, Room 9. LOCATIONS FOR TB SKIN TESTS (PPD) ONLY EOC Health Services 1047 R Street (Between Fresno St & Tulare St) Phone: General Information Walk-Ins Accepted No Appointment Needed Monday, Tuesday, Wednesday 8:30 a.m. to 12:00 p.m. & 2:30 p.m. to 4:00 p.m. Not Open On Thursdays Friday 9:00 a.m. to 11:00 a.m. & 1:30 p.m. to 4:00 p.m. Cost $15 Per TB Skin Test (Cash Only) You may also call the School Nurse at any school site listed below to schedule an appointment School Sites Phone Numbers Herndon-Barstow Elementary School El Capitan Middle School River Bluff Elementary School Central East High School , Extension 133 INFORMACIÓN PARA PADRES VOLUNTARIOS/ACOMPAÑANTE Si desea ser voluntario en el salón de clase preescolar de su hijo o ser un acompañante en un viaje de estudio, usted necesitará presentar los siguientes documentos: Una complete aplicación de voluntario/acompañante Una copia de su tarjeta de identificación La prueba de piel de Tuberculosis y resultado hecho después del 1 de Agosto del año pasado o Si la prueba de piel de Tuberculosis es positiva, una radiografía de tórax es necesaria y debe presentar prueba escrita (sólo una vez) Padres quienes son voluntarios por dos veces por semana o más deben hacerse la prueba de huellas digitales al Departamento de Recursos Humanos, Sala 9. UBICACIONES PARA PRUEBAS DE PIEL DE TUBERCULOSIS SOLAMENTE EOC Health Services 1047 R Street (Entre Fresno St y Tulare St) Teléfono: Información General Camine-En Aceptado No Necesita Cita Lunes, Martes, Miércoles 8:30 a.m. a 12:00 p.m. y 2:30 p.m. a 4:00 p.m. No está abierto los jueves Viernes 9:00 a.m. a 11:00 a.m. y 1:30 p.m. a 4:00 p.m. Coste $15 por prueba de piel TB (sólo en efectivo) Puede llamar a la enfermera de la escuela en cualquier sitio de la escuela a continuación para hacer una cita Sitios Escolares Números de Teléfono Herndon-Barstow Escuela Primaria El Capitan Escuela Intermedia River Bluff Escuela Primaria Central East High Escuela Secundaria , Extensión 133