Revised 04/12/2010 Page 1 of 2. Birth Certificate ID # Immunization Records. Residential Address / La Dirección Residencial
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1 Revised 04/12/2010 Page 1 of 2 MAGNOLIA INDEPENDENT SCHOOL DISTRICT FOR OFFICE USE ONLY ENROLLMENT DOCUMENTS INITIAL STUDENT REGISTRATION & EMERGENCY INFORMATION FORM MAGNOLIA SIXTH GRADE CAMPUS 110 S. Magnolia Blvd; PO BOX 1540 Magnolia, Tx Phone Fax Birth Certificate ID # Immunization Records Grade Proof of Residence Teacher Social Security Card Section Last report card/withdrawal records Bus # Last TAKS scores Copy of Enrollee's ID PLEASE PRINT / USAR LETRA DE MOLDE STUDENT INFORMATION / INFORMACIÓN DEL ESTUDIANTE GRADE/GRADO LAST NAME / APELLIDO FIRST NAME /PRIMER NOMBRE MIDDLE NAME SEGUNDO NOMBRE GENERATION /GENERACIÓN (Jr., III, etc.) Gender /Genero Male/niño Female/niña Age as of September 1 / Edad desde Septiembre 1 Residential Address / La Dirección Residencial of Birth/Fecha de Nacimiento Place of Birth /Ciudad y Estado de Nacimiento City / Cuidad State/Estado Zip/ Zona Postal Home Phone / Teléfono de casa Subdivision / Complex / Colonia Cell Phone / Teléfono celular With whom does the student live? / Con quién reside el estudiante? Mailing Address - Complete only if different from residential address La Dirección de Correspondencia - Llene somamente si es diferente a la dirección residencial Both Parents / Ambos Padres Father / Padre City / Cuidad State / Estado Zip / Zona Postal Other / Otro SCHOOL / PROGRAM INFORMATION / ESCUELA / INFORMACIÓN DEL PROGRAMA Has student ever been enrolled in special classes? El estudiante ha asistido a clases especiales? Mother / Madre Please mark Yes or for each program. / Por favor marque sí o no para cada programa. Has your child lived outside the U.S. for two or more consecutive years? Ha vivido su hijo/a fuera de los Estados Unidos por dos o más años consecutivos? Special Education / La Educación Especial If yes, when? from month/year to month/year Bilingual-ESL / Bilingüe-ESL Gifted and Talented / Talentoso y Dotado Where?/ Dónde? Title I / Título I 504 Program / 504 Other / Otro Grade?/ Grado? Which Grade(s)? / Cuáles grados? Has student ever attended Magnolia Schools? When? En el pasado ha asistido el estudiante escuelas en Magnolia? Cuándo? When?/ Cuándo? Reading Recovery / Descubriendo la lectura Dyslexia / Dislexia Speech / Terapia de hablar Has student ever skipped a grade? / El estudiante ha saltado un grado? Has student ever been retained or repeated grade level(s)? / Ha reprobado un grado el estudiante? Si, sí, de mes/año a mes/año When your child lived outside the U.S., did he or she attend school regularly? / Cuando su hijo/a vivia fuera de los Estados Unidos, asistio con regularidad a la escuela? Yes, in the past my child attended school regularly. / Sí, en el pasado mi hijo/a asistió la escuela con regularidad., my child missed the following: /, mi hijo/a perdió lo siguiente: first enrolled in U.S. schools? Cuál es la fecha original de matriculación en las escuelas de los E.U.A.? How many school years has your child attended at least one day of school in the United States? / Cuántos años escolares su niño ha asistido por lo menos un día en escuelas de los Estados Unidos? Last Schools Attended / mbre de las escuelas asistidas mas recientes Year / Año City / Ciudad State / Estado Continued on page 2 (back) / Continuado en la página 2 (trasera)
2 Revised 04/12/2010 Page 2 of 2 MAGNOLIA ISD STUDENT REGISTRATION FORM CONTINUED PLEASE PRINT / USAR LETRA DE MOLDE Please repeat STUDENT NAME / Por Favor repita el nombre del estudiante GRADE /GRADO LAST NAME / APELLIDO FIRST NAME / PRIMER NOMBRE MIDDLE NAME /SEGUNDO NOMBRE GENERATION /GENERACIÓN (Jr., III, etc.) PLEASE LIST GUARDIANS IN PREFERRED CALLING ORDER / POR FAVOR ESCRIBA LOS GUARDIANES EN ORDEN DE PREFERENCIA A LLAMAR 1. GUARDIAN INFORMATION / INFORMACIÓN DEL GUARDIAN MOTHER/MADRE LAST NAME / APELLIDO FIRST NAME / PRIMER NOMBRE FATHER/PADRE OTHER/OTRO Mailing Address /La Dirección de Correspondencia Place of Employment / Lugar de Empleo Address of Employment / La Dirección del Empleo Phone / Teléfono de Casa Cell Phone / Teléfono Celular Work Phone / Teléfono de Trabajo Address / Dirección del correo Electrónico 2. GUARDIAN INFORMATION / INFORMACIÓN DEL GUARDIAN MOTHER/MADRE LAST NAME / APELLIDO FIRST NAME / PRIMER NOMBRE FATHER/PADRE OTHER/OTRO Mailing Address /La Dirección de Correspondencia Place of Employment / Lugar de Empleo Address of Employment / La Dirección del Empleo Phone / Teléfono de Casa Cell Phone / Teléfono Celular Work Phone / Teléfono de Trabajo Address / Dirección del correo Electrónico EMERGENCY CONTACT(S)-someone other than Parent/Guardian / CONTACTO DE EMERGENCIA- alguien con excepción al padre/guardian I understand that if the school can not reach the parent/guardians listed above the following people will be contacted and have my permission to pick up my child. / Entiendo que si la escuela no puede comunicarse con el padre/los guardianes las siguientes personas serán comunicadas y tienen permiso para recoger a mi niño. Name / mbre Daytime Phone / Numero durante el día Relationship / Relación Name / mbre Daytime Phone / Numero durante el día Relationship / Relación STUDENT MEDICAL INFORMATION / INFORMACIÓN MÉDICA DEL ESTUDIANTE Does the student have any allergies or medical conditions? Tiene el estudiante alguna alergia o condiciones médicas? PLEASE LIST ALLERGIES AND MEDICAL CONDITIONS POR FAVOR ENLISTE ALERGIAS Y CONDICIONES MEDICAS Does the student take medication? Toma medicamentos el estudiante? PLEASE LIST ALL MEDICATIONS THAT STUDENT TAKES AT HOME OR SCHOOL POR FAVOR UNA HAGA LISTA DE TODOS LOS MEDICAMENTOS QUE TOMA EL ESTUDIENTE EN CASA O LA ESCUELA Doctor Doctor's Phone / Teléfono del Doctor LIST OTHER CHILDREN LIVING IN HOUSEHOLD / ESCRIBA LOS NOMBRES DE OTROS NIÑOS QUE VIVEN EN EL HOGAR NAME / NOMBRE AGE / EDAD GRADE / GRADO SCHOOL ATTENDING / ESCUELA INFORMATION OF PERSON ENROLLING STUDENT (ID Required) INFORMACIÓN DE LA PERSONA MATRICULANDO AL ESTUDIANTE (Se Requiere Identificación) If a parent indicates on the school district's registration or enrollment form that his or her child is a resident of the district when in fact the child is not eligible, that parent will be charged with violating Penal Code for which a Class A misdemeanor conviction may result. Additionally, false information will make the parent or other person liable for tuition and other operating cost of the district. Si un padre indica en la matrícula del distrito de la escuela o forma de matriculación que su niño es un residente del distrito cuando de hecho el niño no es elegible, el padre será acusado de violar Código Penal 37,10, para cuál una convicción clase A de delito puede resultar. Adicionalmente, información falsa hará el padre o a otra persona responsables de costos del distrito. LAST NAME / APELLIDO FIRST NAME / PRIMER NOMBRE of Birth/Fecha de Nacimiento Relationship to student / Relación al Estudiante Residential Address / La Dirección Residencial Signature/Firma /Fecha
3 ~ LGNOLIA I.. OEPENOENT SCHOOl. DIST'RlCT Magnolia Independent School District HOME LANGUAGE SURVEY 19TAC Chapter 811, Subchapter BB TO BE COMPLETED BY PARENT OR GUARDIAN (OR STUDENT IF GRADES 9-12): The state of Texas requires that the following information be completed for each student that enrolls for the first time in Texas public schools. This suney shall be kept in each student's record folder. NAME OF STUDENT STUDENT ID# ADDRESS TELEPHONE # CAMPUS 1. What language is spoken in your home most of the time? 2. What language does your child speak most of the time? Signature of Parent/Guardian Signature of Student if Grades 9-12 Cues tiona rio del idiom a que se habla en el hogar DEBE DE COMPLETARSE POR EL PADRE/MADRE/ 0 REPRESENT ANTE LEGAL: (0 POR EL ESTUDIANTE Sl ESTA EN LOS GRADOS 9 12): El estado de Texas requiere que Ia siguiente informaci6n se complete para cad a estudiante que se matricula por primera vez en una escuela publica de Texas. Este cuestionario se archivara en el expediente del estudiante. NOMBRE DEL ESTUDIANTE.s/0. OIRECCION TELEFONO ESCUELA 1. <.Que idioma se habla en su hagar Ia mayoria del tiempo? 2. <.Que idioma habla su hijo/a Ia mayoria del tiempo? Firma del Padre/Madre/ o Representante Legal Firma del estudiante si esta en los grados 9-12 Fecha Fecha Texas Education Ageocy BilinguaVESL Unit Spanish
4 Texas Education Agency Texas Public School Student/Staff Ethnicity and Race Data Questionnaire The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff. This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC). School district staff and parents or guardians of students enrolling in school are requested to provide this information. If you decline to provide this information, please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting. Please answer both parts of the following questions on the student s or staff member s ethnicity and race. United States Federal Register (71 FR 44866) Part 1. Ethnicity: Is the person Hispanic/Latino? (Choose only one) Hispanic/Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. t Hispanic/Latino Part 2. Race: What is the person s race? (Choose one or more) American Indian or Alaska Native - A person having origins in any of the original peoples of rth and South America (including Central America), and who maintains a tribal affiliation or community attachment. Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. Black or African American - A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. White - A person having origins in any of the original peoples of Europe, the Middle East, or rth Africa. Student/Staff Name (please print) Student/Staff Identification Number (Parent/Guardian)/(Staff) Signature This space reserved for Local school observer upon completion and entering data in student software system, file this form in student s permanent folder. Ethnicity choose only one: Race choose one or more: American Indian or Alaska Native Hispanic / Latino Asian Black or African American t Hispanic/Latino Native Hawaiian or Other Pacific Islander White Observer signature: Campus and : Texas Education Agency March 2010
5 Magnolia Sixth Grade Campus-Course Requests Magnolia Sexto Grado Cursos Campus Does student receive special services? 504 Special Ed ESL Dyslexia GT Speech Student s Name (mbre de Estudiante) Address (dirección) Street Address City Zip Parent s Names (mbres de los Padres) Phone Numbers (Números de teléfono) Cell Work Required Courses :(Cursos Obligatorios:) The courses listed below are required for all 6th graders. Language Arts (Lengua y Literatura) Math (Matemáticas) Science (ciencia) Social Studies (estudios sociales) Physical Education (Educación Física) If you want to take the pre-ap level of a course or courses, place a check beside the course or courses in which you are interested. (Si usted quiere tomar el nivel de Pre-AP de un curso o cursos, coloque una marca al lado del curso o cursos en los que estás interesado.) Pre-AP LA Pre-AP Math Pre-AP Science Pre-AP Social Studies Electives: Although you are allowed only one elective, please choose more than one, and in your order of preference. 1 is your first choice, 2 is your second choice, and so on. Full year electives Advanced Technology Applications* Art (Arte)* Band (Band) Choir (Coro) * Separate Application Required Semester electives Art (Arte) Choir (Coro) Advanced Technology Studies(Tecnologia) PE Uniform: Circle one uniform size. (PE Uniforme: Círculo de un tamaño uniforme.) Shirt size (Camisa tamaño) Youth (joven) L Adult (adulto) S M L Shorts size (pantalones cortos tamaño) Youth (joven) L Adult (adulto) S M L Parent Signature (Firma del Padre) (Fecha)
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