Complete Application Packet Consists of:

Transcripción

1 Metropolitan Nashville Public Schools Kindergarten Registration Packet Applicant s Name Applicant s Date of Birth Applicant s Age as of August 15 th, 2016 Complete Application Packet Consists of: All Registration Forms Completed and Signed Parent/Guardian s Photo Identification Birth Certificate or acceptable proof of age Proof of Residency Certificate of Immunization Physical Exam Record within 12 months from any US State Applicant s 190 Provided by MNPS

2 Preschool Experiences Child's Name Date of Birth District you are registering your child to attend in Name of preschool program(s) your child attended in , if applicable City and state where preschool program is located Tell us where your child attended preschool. Check ALL options that apply Attended half day (1-4 hours) Tell us how often your child attended preschool. Attended full day (5 or more hours) Number of days attended per week Number of months attended between August 2015 and August 2016 Public school pre-kindergarten (Pre-K classroom in a K-4 or K-12 public school, including elementary, middle, and/or high schools and charter schools ) Private school pre-kindergarten (Pre-K classroom in a K-4, K-6, K-8 or K-12 non-public, tuition-based school ) Head Start Child Care Center or Preschool (Pre-K, K, 4s, 5s, or 3-5 yr old classroom at a public, private, or religious based preschool program ) Stayed home with parent/guardian Home-based child care (child care provided in an individual s home that is not the parent/guardian ) Don t know/chose not to answer If your child attended more than one preschool program between August 2015 and August 2016, please list the name of the program(s) and how many months he/she attended each program. 1) 2) 3) Thank you for your responses. This information will help us meet the needs of your child by understanding more about their preschool experiences.

3 Tennessee Department of Education (TDOE) Title I, Part C of the Elementary and Secondary Education Act (ESEA) Migrant Education Program Occupational Survey Student Information: DATE: Last Name First Name Gender Race District: School: Grade: School 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 a factory processing foods or working in agriculture, fishing, or dairy (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 a factory processing foods or in agriculture, fishing, or dairy? (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 or did 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 or 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 in Tennessee? months years 5. What is your current address? Street Address City State Zip Code 6. What is your current telephone number with the area code? ( ) NOTE TO THE SCHOOL: Please send all surveys with at least one yes response to your district migrant liaison. Please make sure the form is filled out completely. NOTE TO DISTRICT MIGRANT LIAISON: All surveys with at least one yes answer should be uploaded to the TNMEP site upon receipt. Please migranted@blomand.net to inform Jessica Castañeda that new surveys have been uploaded. June 2015 TN form #ED-5438

4 Tennessee Department of Education (TDOE) Title I, Part C of the Elementary and Secondary Education Act (ESEA) Programa de Educación para Estudiantes Migrantes Encuesta Ocupacional Nombre del Estudiante: FECHA: Nombre Apellido Sexo Raza Distrito: Escuela: Grado: Año Escolar: El programa de educación para los estudiantes migrantes [MEP] es parte del Departamento de Educación Pública del Estado de Tennessee [TDOE] provee servicios a los niños y familias que se han mudado a Tennessee en los últimos 3 años. Para calificar por el programa, las familias deben de haberse mudado de un lugar a otro buscando trabajo temporal en agricultura, ganadería, o pesca. El programa registra a niños y jóvenes entre las edades de 3 a 21 años. Agradecemos que nos ayuden a determinar si su niño o pariente califica para recibir servicios de este programa. Por favor, conteste las siguientes preguntas y entregue este documento a la escuela. 1. Vino Usted o alguien en su familia en busca de trabajo temporal en agricultura, el campo, una finca (ejemplo: sembrando/cultivando/cosechando tabaco, papas, algodón, fresas, viveros, trabajo con árboles, etc.), o de pesca (empacadora de pescado o mariscos) o alguna fábrica que procesa alimentos como cerdos, pollos, vegetales, etc.? SÍ NO Si su respuesta es sí, por favor, indique que miembro de su familia hizo este tipo de trabajo. Madre Padre Hijos Otros 2. Trabaja ahora Ud. o alguien en su familia en agricultura (ejemplos: tabaco, papas, algodón, fresas, viveros, trabajo con árboles, etc. ), en una lechería o en una fábrica procesando comida (puerco, pollo, vegetales, etc.)? SÍ NO Si su respuesta es sí, por favor, indique que miembro de su familia hace este tipo de trabajo. Madre Padre Hijos Otros 3. Si su trabajo actual no se relaciona a la agricultura ni pesca, Ha trabajado Usted o algún miembro de su familia en este tipo de actividades en los últimos 3 años? SÍ NO Dónde? Ciudad Estado País Si usted contestó "sí" a alguna de las preguntas anteriores, por favor, conteste las preguntas abajo (#4, 5 y 6). 4. Hace cuánto tiempo que se mudó a este condado? Mes Año 5. Cuál es su dirección actual? Dirección Ciudad Estado Código Postal 6. Cuál es su número de teléfono actual (con el código de área)? ( ) NOTE TO THE SCHOOL: Please send all surveys with at least one yes response to your district migrant liaison. Please make sure the form is filled out completely. NOTE TO DISTRICT MIGRANT LIAISON: All surveys with at least one yes answer should be uploaded to the TNMEP site upon receipt. Please migranted@blomand.net to inform Jessica Castañeda that new surveys have been uploaded. June 2015 TN form #ED-5438

5 Residential Address City State Zip Apt # Country Household Phone Number Mailing Address (if different from Residential Address) Address City State ZIP Last Name First Name MI Sex Relationship to Student Home Phone Work Cell Phone circle all that apply Last Name First Name MI Sex Relationship to Student Home Phone Work Cell Phone portal / attendance / behavior / mailings/ teacher/ message portal / attendance / behavior / mailings/ teacher/ message EMERGENCY CONTACT Sequence EMERGENCY CONTACT Sequence ****Student information provided must match student's Birth Certificate**** Mother's Maiden Last Name (info from the Birth Certificate) Student 1 ID# Last Name First Name Middle Name DOB / / Last Name First Name Middle Name DOB / / Sex Social Security # Sex Social Security # Last Name First Name Middle Name DOB / / Metro Nashville Public Schools Student Registration Parents/Guardians Living in the Household With Student circle all that apply Student 2 ID# Student 3 ID# Student 4 ID# Last Name First Name Middle Name DOB / / Sex Social Security # Sex Social Security #

6 Residential Address Parents/Guardians Living at a Different Address Other Than The One Listed Above Does this parent/guardian have joint custody? Last Name First Sex Relationship to Student Mailing address APT# City State: Zip: Household Phone ( ) - - Cell Phone ( )- - Does this parent/guardian have joint custody? Y N Student 1 Student 2 Student 3 Student 4 Student 1 Student 2 Student 3 Student 4 Last Name First Sex Relationship to Student page 2 Mailing address APT# City State: Zip: Household Phone ( ) - - Cell Phone ( )- - portal / attendance / behavior / mailings/ teacher/ message portal / attendance / behavior / mailings/ teacher/ message 1st Emergency Contact circle all students that apply circle all students that apply If School Personnel cannot reach the parent/guardian with the phone numbers listed on Page 1, who do we call and in what order? Name Phone# ( )- - 2nd Emergency Contact Name Phone# ( )- - Home Language Survey TENNESSEE STATE BOARD OF EDUCATION ESL PROGRAM POLICY 3.207, states that: "each School District must administer the The information is used to identify the need for English language support services for the student. List Student's first name Student 1 Student 2 Student 3 Student 4 1. What is the first language this child learned to speak? 2. What language does this child speak most often outside of school? 3. What language do people usually speak in your child s home? Please note : If the answer to question(s) 1, 2, or 3 is not English, The Office of EL will assess the student's English language proficiency and additional forms will need to be completed. Statement of Residence: Where does the student stay at night? (Please check ONE) Home/Apartment owned or rented by the student's parent/legal guardian in a motel a campsite in an automobile With a relative or friend (family does not have a residence) Other housing (please explain) I certify that the above information is true, accurate, and subject to verification. If any information is found to be fraudulent the student may be subject to withdrawal and the parent/legal guardian subject to tuition reimbursement (TCA ). Parent/Guardian signature required for enrollment Date Enrollment stamp here MNPS use only Student ID: Student PIN Start Date: Enrolled at- ES Center Zoned School Comments 4/4/2016