Portland Public Schools Enrollment Handbook

Portland Public Schools Enrollment Handbook (2013-2014) Portland Public Schools recognizes the diversity and worth of all individuals and groups and their roles in society. All individuals and groups shall be treated with fairness in all activities, programs and operations, without regard to age, color, creed, disability, marital status, national origin, race, religion, sex, or sexual orientation. Board of Education Policy 1.80.020-P District Title VI Title IX: Greg Wolleck American Disabilities Act Contact: Jeff Fish, Legal Counsel Human Resources BESC Enrollment & Transfer Center, Office of Schools and Information Technology SIS August 2013

TABLE OF CONTENTS PURPOSE OF ENROLLMENT HANDBOOK... 1 Enrollment Data... 1 DEFINITIONS... 2 DISTRICT REQUIRED ENROLLMENT PROCEDURES... 4 Adult Education... 4 Alternative Education (Education Options)... 4 Athletics (Home Schooled or Private School Students)... 4 Charter School Non-Resident Student receiving Special Education Services... 4 Columbia Regional Programs... 4 Community Transition Program (CTP) (aka CTC in Synergy)... 4 DESCC Students attending the Delayed Expulsion School Counseling Center... 5 ESL Students / Family Support Centers... 5 Foreign Exchange Students... 5 Foster Children Senate Bill 414... 5 Guardianship Arrangements... 5 Home Schooled Students/Private Parochial Students... 6 Homeless Students... 6 Jefferson Dance Students... 7 Maternity Leave... 7 Medical/Safety Leave... 7 Online Charted Schools... 8 Pioneer - Short-Term Education Placements... 8 Pre-Kindergarten (Pre-K) students receiving Special Ed Services... 8 Private School Students - See Home Schooled Students on page 6... Regular Student Enrollment No Special Circumstances... 9 Section 504 Students... 10 Special Education Services Full Time Student... 10 Students of Legal Age... 10 Students Studying Abroad... 10 Teen Parent Services See Maternity Leave on page 10... 10 Transfers from Out-of-District (Inter-district transfers)... 11 Transfers within the District (intra-district transfer) School Choice Transfer Process... 11 Tuition Based Enrollment Non-Residents... 12 Tutoring Students Receiving & Not Receiving Special Education Services... 12 Contact Information... 12 APPENDIX A. Portland Public Schools: Policies and Administrative Directives... 13 4.10.010-P Compulsory Enrollment and Attendance 4.10.011-AD Student Enrollment Immunizations 4.10.020-P Age At Entrance 4.10.032-P Early School Entrance 4.10.033-AD Early Entry into Kindergarten and First Grade 4.10.040-P Admission of Nonresident Students 4.10.041-AD Tuition Information 4.10.045-P Student Assignment to Neighborhood Schools 4.10.045-AD Minors Not Living with Parents or Guardians 4.10.047-AD Residency & Neighborhood School Assign 4.10.051-P Student Enrollment and Transfers 4.10.054-AD Student Transfers 4.10.055-AD Attendance Areas and Transfers Boundary Changes 4.10.056-AD Families Who Move 4.10.070-AD Students Expelled Readmission 4.10.090-AD Interdistrict Agreements and Transfer of State School Funds B. State Laws Regarding School Enrollment......59 i

Oregon State Law, Chapter 339, Sections Regarding School Enrollment: 339.010 School attendance required; age limits 339.020 Duty to send children to school 339.030 Exemptions from compulsory school attendance 339.035 Teaching by private teacher, parent or guardian; notice 339.115 Admission of students: waiver; denial 339.125 Admission of nonresident pupils; costs 339.129 Education for children in local or regional correctional facilities required 339.133 Residency of student for school purposes 339.134 Residency of child with disability 339.137 Residency of student at youth care center C. Enrollment and Transfer Center Forms, Guidelines & Letters... 64 Welcome to PPS Enrollment Info Letter Declaration Of Residency Memo Declaration of Residency Form English & Spanish Resident Relocation Guidelines Resident Relocation Form Non-Resident Student Guidelines Non-Resident Student Form English School Choice Administration Admin Tools D. DHS Senate Bill 414... 77 DHS Senate Bill 414 Information DHS Student Education Records Protocol Flow Chart Sample DHS Custody Letter Parental Notice Template for Sped Students Only SB 414 Memo of Understanding Court Order Sample Synergy Procedure for student in custody of DHS E. Portland Public Schools Forms & Information... 89 DESCC Referral Form PPS Fee-for-Service Kindergarten PPS Fee-For-Service Kindergarten Contract English & Spanish Tuition Discount Application Fee-for Service Kindergarten Authorization for Direct Payment Checking or Saving Authorization for Use of Visa/MasterCard Payment of Tuition Records Request Form Nutrition Services Free & Reduced Information, Instructions & Form English & Spanish PPS Registration Form F. Synergy Information... 118 Synergy Quick Reference Guides E1 Enrolling Students D10 Concurrent Enrollment ii

PURPOSE OF ENROLLMENT HANDBOOK The goal of this Enrollment Handbook and the implementation of its directives are: To provide consistent and appropriate enrollment policies and practices that will ultimately result in improving the enrollment process for parents, students and staff. It is the expectation of the Superintendent that all Portland Public Schools will follow the practices stated in this handbook. We realize, however, that a handbook such as this is an evolving document. The materials will be reviewed annually and, where appropriate, updates will be instituted. Enrollment Data The information entered into Synergy flows to the State of Oregon Department of Education, Health Department, School Board, PPS Administration and sometimes the news media. The information is used to support student achievement, attendance and to account for State funding. Synergy Information Used For: Enter and Leave Dates State of Oregon school funding Enrollment counts for staffing (FTE) Early Leaver Reporting Nutrition Services Systems Tracking attendance accurately (PPS #1 Vital Sign) Valid Addresses in or out of neighborhood or district School profiles used by the School Board Transportation Department District and school mailings School Choice ADA: Average Daily Attendance DEFINITIONS ADM: Average Daily Membership Age Appropriate Enrollment: Students may be enrolled in a public school until they reach the age of 19. The student may be enrolled in the year they turn 19 if they have not already turned 19, and they remain in school until they withdraw or the school year ends. (Special Education students may continue through the age of 21). Students who do not meet the age requirement but have completed an accredited program may enroll at another grade level. Contact the TAG department at (503) 916-3358 for these situations. Cohort Graduation Rate: A cohort graduation rate is the percentage of first-time ninth graders in a particular school year who graduate within a given time frame, such as four years or five years. For example, a four-year cohort graduation rate for the first-time ninth graders in 2006-07 school year would represent 1

the percentage who graduated by the end of the 2009-10 school year. (2010-11 Oregon Department of Education Cohort Technical Manual Version 1.0) Concurrent Enrollment: A process that allows another school or program to view student information when they are not the home school. Enroll: To enter enrollment information into the student information system. Once enrolled, another school cannot enroll the same student. Enrollment Packet: Each school should have an enrollment packet. The Enrollment Packet generally includes the basic First Day of School packet information and is handed out to any new student who enrolls at your school. Enrollment Packet suggestions: school calendar, current newsletter, Nutrition Services Free & Reduced form and information, and transportation information. ETC: Enrollment and Transfer Center. ETC is designed to support families and school staff by providing a coordinated system for school choice and enrollment processes in one central location. ETC staff provides information about District enrollment procedures, services, and educational options with the goal of equal access and the ability to assist families in making informed choices about their student s education. ETC facilitates a wide variety of enrollment processes and services. The PPS Enrollment Options Chart lists these services, with details provided in this section of the Administrator s Handbook. Parents should be referred to the main phone number for assistance. All staff is cross-trained in all department processes to provide assistance when needed. Fee-For-Service Kindergarten: Families enrolling in full-day kindergarten at non-title I schools must complete a fee-for-service contract at registration. The contract explains monthly tuition, payment plans and scholarships. To download contracts, payment forms and scholarship information, go to: PPS Inside > Forms > Fee-For-Service (See Appendix E). Functional Life Skills Students: Students enrolled at MESD who are cross-enrolled to school site where their class is held. PPS staff is not required to do anything with these students. Head Start: Head Start programs are in centers (like Sacajawea and Applegate), and school sites (such as James John and Lent). Head Start offers both full and half-day options. Enrollment is handled at Head Start, and families have to meet federal income guidelines. Families wishing to continue in the school for kindergarten have to apply through school choice if the Head Start school is not their neighborhood school. MESD: Multnomah Educational Service District Non-Resident: Student who does not reside within the boundaries of Portland Public Schools ODE: Oregon Department of Education Petition Transfer: PPS understands that sometimes families face urgent situations that may require the immediate movement of a student from one school to another. When families face extraordinary circumstances that pose imminent health, safety or serious educational concerns, a Petition Transfer process is available. ETC makes the final determination based on the Petition Transfer guidelines, the information submitted by the parent/guardian, and consultation with school staff, administrators, and other service providers. Please refer these situations to ETC (503) 916-3205. 2

Register: To register a student means to input an enter date when the student actually began attending school. The correct enter date is very important for ADM reporting to the Oregon Department of Education. Resident Relocation: Students who move during the year can remain at the school they are attending. The Resident Relocation form is used by schools for families within the district who wish to have their student remain in the school they are attending. School staff forwards the Resident Relocation Form to ETC. A letter will be sent to families and schools upon completion of the process. NOTE: the transfer policy allows students to remain at the currently enrolled school until the highest grade level. (Non-resident students currently attending PPS on an inter-district transfer must show proof of PPS residency if they move into PPS.). Resident Student: Public schools in Oregon are required to provide schooling for students whose residence is within the boundaries of the district. Public schools are not required to provide school for students whose residence is in another school district, state, country, or for students who reside in the district for the primary purpose of attending school. According to Portland Public Schools regulations the term residence signifies the place where a child resides with some degree of permanency with the parent/guardian or supervising adult. If a family cannot provide proof of residency and is in transition due to economic hardship, please contact Project Return at 971-219-1446. Please contact ETC if you have any questions at 503-916-3205. Transitioning Students: Students that are requesting to attend a Portland Public School and have been absent from a public school setting for at least 20 consecutive school days and are transitioning from residential mental health, alcohol/drug treatment programs, DART or other day treatment programs and/or involved in the juvenile justice system, need to be referred to Direction Services for placement in the most appropriate school setting. Contact Direction Services at 503-916-3956. Washington Residents: Students residing in the state of Washington may only enroll in Portland Public Schools if they pay tuition and space is available. Follow the Transfers from Out-of-District (inter-district transfer) procedure. 3

DISTRICT REQUIRED ENROLLMENT PROCEDURES Adult Education Students who are not on track to receive a standard high school diploma can be enrolled in a GED program, an adult high school diploma program or another post-secondary education. Enroll in Synergy following the regular enrollment process. Alternative Education (Education Options) Students who are at risk of dropping out of school or whose educational needs are not being met in a traditional school setting may qualify for placement in a District or community based alternative program. Alternative programs are designed to increase achievement in smaller learning communities. Alternative programs must develop an alternative education plan for qualifying students and have that plan approved by the Education Options Office. District staff, parents or students are encouraged to contact a placement specialist in ETC for placement criteria and program information. For detailed information and available Alternative Education Programs visit the Education Options website http://159.191.14.143/.docs/pg/10043. Athletics (Home Schooled or Private School Students) Students who reside in your attendance area and are home schooled or attend a private school, are allowed to participate in athletics. 1. Collect a completed and signed registration form from the parent/guardian or supervising adult. 2. Enroll the student into Synergy SIS with the NS: Extra-Curricular Activities enter code. 3. School schedules the student into courses. The school will be able to input attendance and grades accordingly. The student will not report to the state. Charter School Non-Resident Student receiving Special Education Services Students with an IEP attending a PPS Charter School and do not reside within PPS boundaries: 1. Collect a completed and signed registration form from the parent/guardian or supervising adult. 2. Enroll the student into Synergy SIS with the NS: Special Education Services Only enter code. 3. On Enrollment screen, select Resident under the Status, and the name of the district where the student lives under the Legal District of Residence. 4. Type in the Effective Date -- the student s first day of enrollment after approval. Columbia Regional Programs PPS students receiving services for Autism, Deaf and Hard of Hearing, Orthopedic, or Vision through Columbia Regional Programs. 1. Enroll student using the standard enrollment process. 2. Columbia Regional will concurrently enroll students approved for services to the Regional program and also to their district of residence Outside Placement school. NOTE for Sunnyside, Mt. Tabor and Cleveland: If a student in the Deaf and Hard of Hearing program is from another school district, enroll as Non-Resident Status, and enter the district where the student lives under the Legal District of Residence, and select Paid by Resident District as the Tuition Payer Code. Community Transition Program (CTP) The Community Transition Program (CTP) serves students with IEPs who graduate from high school with modified or extended diplomas or who have completed four years with an alternative certificate. The 4

purpose of the program is to support young adults in their transition to life after high school. Enroll the student with the standard enrollment process. DESCC Students attending the Delayed Expulsion School Counseling Center The Delayed Expulsion School Counseling Center is a disciplinary Action Level 4 delayed expulsion alternative available to middle and high school students. 1. School administrators fill out DESCC referral form (see Appendix E). 2. DESCC staff creates a concurrent enrollment for the student and selects the NS: Concurrent Use Only enter code. 3. When the student has successfully completed the DESCC program and has returned to the home school, DESCC staff ends the concurrent enrollment. ESL Students / Family Support Centers When the Family Support Center is available, staff assists schools by assessing and enrolling students who speak a language other than English into Synergy. Contact ESL for additional information. Foreign Exchange Students Students from foreign countries may be approved to enroll in high schools if they are sponsored by a District approved program and local host family, meet admission requirements set forth in the District guidelines, and are approved by the neighborhood school of the host family. The maximum length of the enrollment is one year. To ensure consistent application of the guidelines and coordination of services, exchange program representatives are asked to communicate directly with the PPS Enrollment and Transfer Center (ETC) regarding placement. A Clearance for Registration will be issued when a student has met all District and immunization requirements. 1. Verify the student has Clearance for Registration form from ETC. 2. Enroll student into Synergy to the approved school following the standard enrollment process. 3. On the Student > Other Info > Graduation Information screen, select the Honorary type in the Diploma Type field. 4. ETC will assign the student to the Foreign Exchange program assignment in Synergy. Foster Children Senate Bill 414 Senate Bill 414 is a law passed by the 2007 legislature regarding children in foster, residential or group care under the custody of DHS. Much of the measure addresses placement of siblings in care as well as the need to track the progress of students in care. The bill also includes a provision requiring DHS workers to report to the court on school attendance and school progress. See Appendix D more information regarding Senate Bill 414 and for Synergy procedures. Guardianship Arrangements Students who are living with someone other than their parents or legal guardian must have clearance through ETC to enroll unless the student is 18. Students meeting hardship requirements become a PPS resident and enroll in the neighborhood school. These students can transfer to other district schools through the regular transfer process. Please refer these situations to ETC. A Clearance for Registration will be issued for qualifying students. 1. Verify that Clearance for Registration form has been issued by ETC. 2. Enroll the student into Synergy following the standard enrollment process. 3. List the supervising adult as the guardian. 5

Home Schooled 1 and Private/Parochial School Students 2 Follow these enrollment steps for either scenario: 1 Home schooled students who come to a PPS school for any reason. Home schooled students must be registered with MESD. Parents and schools can contact MESD at 503-257-1651 for additional information. 2 Students who attend a private or parochial school and attends a PPS school for any reason. Needs an SSID for Testing 1. Enroll the student with the NS: For Testing Purposes Only. 2. If the student needs an SSID immediately, contact SIS Support at (503) 916-3375 option 2. Not Receiving Special Education Services Home schooled or private/parochial school student taking 1-2 regular education classes that total less than 100 min per day. 1. Obtain Registration form and enroll the student into Synergy with the NS: Private/Home Schooled, Attending Part-Time enter code. 2. Assign the student to a course(s). 3. Track and email the student s instructional hours to sis@pps.net on a quarterly basis. Receiving Special Education Services Home schooled or private/parochial school student approved to receive PPS Special Education services. 1. Obtain Registration form and enroll student into Synergy with the NS: SpEd Services Only enter code. 2. Track the email the student s instructional hours to sis@pps.net on a quarterly basis. Homeless Students Student meets homeless criteria as defined by Project Return (503-916-5770). Who qualifies? Students who are doubled up, sharing housing due to loss of housing or economic hardship Students living in motels, trailer parks or camp grounds due to the lack of alternative accommodations Students living in emergency or transitional shelters Students who are living in cars, parks, public spaces or substandard housing Students who are unaccompanied, living without their parents Migratory students who qualify as homeless because the students are living in circumstances listed above Student rights: Go to school, no matter where they live or how long they have lived there Continue in the school that they last attended before becoming homeless Receive transportation to the school they last attended Enroll in school without giving a permanent address Enroll and attend classes while the school arranges for the transfer of Immunization records or any other documents required for enrollment Enrolling Students into Synergy: 1. Enroll the student into Synergy following the standard enrollment process. 2. Send copy of Registration form to Project Return. 3. Project Return will assign the student to the Title X Part C program assignment in Synergy. 6

Jefferson Dance Students In-district, PPS schools only Students who currently attend a PPS school other than Jefferson and are taking a dance course. 1. Jefferson school staff concurrently enrolls the student into Synergy using the NS: Extra-Curricular Activities enter code. Select Exclude form State Reporting in the ADA/ADM field via the Student > Enrollment History tab. 2. Jefferson school staff assigns the student the dance course(s) in Synergy. Outside-of-district schools Students who currently attend a school outside of PPS boundaries and are taking a dance course. 1. Search Synergy for an existing student ID#. If existing, enroll the student using the existing student ID# and select the NS: Extra-Curricular Activities enter code. Skip to Step 3. If no existing student ID#, go to Step #2. 2. Obtain a Registration Form and enroll the student into Synergy with the NS: Extra-Curricular Activities enter code. 3. On the Student > Enrollment tab > Enrollment Activity section, input the following information: a. The Legal District of Residence: The name of the district where the student lives b. Effective Date: The student s first day of enrollment c. Tuition Payer Code: Paid by Parent. d. ADA/ADM: Exclude from State Reporting 4. Jefferson school staff assigns the dance course(s) to the student. Maternity Leave Students who are on maternity leave, but still need to appear on the teacher s class roster. The teacher works with the Teen parent tutor to provide homework assignments. Tutoring/instructional hours are tracked for correct reporting of ADM to ODE. Instructional hours are inputted by Teen Parent Services (TPS) staff. Scenario 1: Student has been accepted into the TPS program, but has not delivered the baby yet. 1. TPS concurrently enrolls the student into Synergy using the NS: Concurrent Enrollment enter code. 2. When the student delivers the baby and no longer attends the home school, TPS ends the concurrent enrollment. Scenario 2: Student has delivered the baby and no longer attends the home school: 1. The home school inactivates the student from Synergy. The leave date is the day the student last attended school, not the day after. 2. The home school notifies TPS (503-916-5858) when the student has been inactivated. 3. TPS enrolls the student into Synergy using the Standard Enrollment enter code. 4. The home school concurrent enrolls the student with the NS: Concurrent Enrollment enter code. 5. TPS inputs instructional hours into Synergy. 6. The home school re-inputs the student s courses. 7. When the student returns to the home school: a. The home school ends the concurrent enrollment b. TPS inactivates the student. The leave date is the day the student last attended TPS. c. The home school re-enrolls the student using the Standard Enrollment enter code. d. The home school re-inputs the student s courses. Medical/Safety Leave Students who cannot attend school for medical or safety reasons and are not receiving tutoring from a licensed teacher (if they are receiving tutoring from a licensed teacher see Tutoring section). 1. The home school inactivates the student from Synergy using the Long-term medical leave enter code. The leave date is the day the student last attended. 7

2. When the student returns, follow the standard enrollment process. Online Charter Schools Students who are enrolled at an online school cannot be enrolled concurrently at PPS. Pioneer Short-Term Educational Placements NOTE: The enrollment steps are the same for all 3 scenarios below Evaluation/Stabilization Students with significant behavior/mental health needs who need a more secure and therapeutic setting for completion of an evaluation for special education eligibility (students not yet eligible) or for evaluation of special education needs (students already on IEPs). This option is for students who demonstrate a significant safety concern. These short-term placements are limited to 6 school weeks. Parental consent is required. Interim Alternative Education Placement ( Interim ) Students who have engaged in one of the big three behaviors: drugs, weapons and/or serious bodily injury. The IEP team decides that a special school placement is appropriate (rather than a CBO alternative education placement). A manifestation determination IEP meeting is required, but the student may be removed to an Interim placement whether or not the behavior is a manifestation of the student s disability. These short-term placements are limited to 45 school days and parental consent is not required. Post-Expulsion Placement Students who engaged in misconduct that resulted in an expulsion. Students on IEPs may only be expelled for behavior that is not a manifestation of their disability. The IEP team decides whether or not a special school placement is appropriate (rather than a CBO alternative education placement). These short-term placements are limited to the duration of the expulsion and parental consent is not required. 1. The home school inactivates the student from Synergy. The leave date is the day the student last attended. 2. Pioneer enrolls the student into Synergy following the standard enrollment process. 3. For tracking purposes, the home can create a concurrent enrollment using the NS: Concurrent Enrollment enter code. 4. Once the program has ended, the home school ends the concurrent enrollment (if applicable), and Pioneer inactivates the student enrollment. 5. The home school re-enrolls the student using the Standard Enrollment enter code. 6. The home school re-inputs the student s courses. Pre-Kindergarten (Pre-K) students receiving Special Ed Services Pre-K students under 5 who are receiving special education services through MESD s MECP program. Contact information: 503-282-4250. 1. Enroll the student into Synergy following the standard enrollment process. 2. If MECP needs to track the student or just needs basic student information, they will have to enroll the student into their own Synergy database. Private/Parochial School Students see Home Schooled and Private/Parochial School Students 8

Regular Student Enrollment No Special Circumstances When a family comes to your building, enroll a student using the following steps: 1. Confirm the adult enrolling the student is either: a. A legal parent/guardian b. Court appointed (DHS) guardian c. Supervisory adult approved through ETC (refer to Guardianship Arrangements in this handbook for more information) 2. Ask the family for their property address. Enter the address online at http://www.pps.k12.or.us/departments/enrollment-transfer/6478.htm to verify that they live in your attendance area. a. If the address is in your attendance area and the student does not have an approved transfer to another school, continue to Step 4. b. If the address is outside your attendance area, refer the family to the appropriate school for the appropriate grade level. c. If the address is outside your attendance area and the student has an approved transfer, continue to Step 4. (Approved transfers appear in Admin Tools. If the student is a non-resident they will have a Clearance For Registration form with them.) 3. Ask the family if the student is in any special programs (i.e. Special Education, 504 Plan, ESL, etc). a. If the student is not in any special program, continue to Step 5. b. If the student is in a special program, refer to the specific section of this Enrollment Handbook and follow the appropriate procedures. 4. Ask the family for two Proofs of Residency. Acceptable forms of Proof of Residency are: current utility bill, credit card or bank statement, casework verification and/or payment voucher, change of address with employer or paycheck stub, state and federal tax return, lease agreement, real estate closing statement, or insurance information. If the family cannot provide proof of residency at the time of enrollment have them fill out the Declaration of Residency form. Note: Refer to the Residency Poster at your school, provided by ETC. 5. If the student is enrolling in Pre-K or Kindergarten, ask the family for Proof of Age. a. Richmond Immersion Pre-K age 4 (on or before 9/1) b. All other Pre-K programs age 4 (on or before 9/1) c. Kindergarten age 5 (on or before 9/1) d. Acceptable forms of Proof of Age are: birth certificate, hospital certificate or baptismal record 6. Give the family the PPS Student Registration Form and Enrollment Packet and collect it after it is filled out. Every student must have a signed, completed Student Registration Form to attend school. All families must fill out the 1st page with the home language survey questions. If a language other than English is spoken, refer the family to Family Support Center, if applicable. 7. Give the family a Records Request Form and collect it after it is filled out. (If the student is PK or KG and never attended another school, you do not have to complete this step.) 8. Ask the family for a copy of the student s most recent immunizations. Let the family know what immunizations are needed by the deadline in February. Parents can visit http://www.mesd.k12.or.us/shs/hss/immunizations/immunization.index.shtml to learn about specific grade level immunization requirements. 9. Ask the family to fill out any other forms your school requests. 10. Inform the family if they qualify for transportation and the times and locations of the bus route near their house. Visit the Transportation website at http://www.pps.k12.or.us/departments/studenttransportation/index.htm to determine transportation eligibility and find bus route/time information. 9

11. Let the family know when the student may begin school. Students must be in school no longer than 24 hours after the time of enrollment. Schools may not delay a student s start date due to the lack of student educational records or special education records. 12. Registration forms must be entered into Synergy within two (2) days of receipt. During September, school staff may forward the student registration/verification forms to IT SIS for data entry. The Data Entry Checklist must be filled out and the minimum required fields must be entered in Synergy before the form may be sent in. All student s data must be as up-to-date as possible to ensure accurate enrollment counts, attendance calls, emergency procedures, etc. Section 504 Plan Students Section 504 of the Rehabilitation Act of 1973 prohibits discrimination against students with disabilities. The District has created a manual to inform school employees about our legal obligations under Section 504. 1. Enroll the student into Synergy following the standard enrollment process. 2. Assign the student to homeroom/course section as instructed by the Special Education staff or Administrator. 3. PPS Central Office staff will assign the student to the 504 Plan program in Synergy once the appropriate paperwork has been collected. Special Education Services Full-Time Student 1. Enroll the student into Synergy following the standard enrollment process. 2. Have the Special Education staff at your school to follow up. NOTE: Schools may not delay enrolling a student due to the student s need for Special Education services. Students of Legal Age Students who are legally emancipated and have attained eighteen years of age are able to enroll themselves in school and permission and/or consent rights required of a parent/guardian shall only be required of the student. 1. Enroll the student into Synergy following the standard enrollment process. 2. In the Synergy Parent screen choose Self as the parent type and fill in the student s information. 3. The student can choose to include or remove any other parent/guardians and/or contacts that might already be listed in the student information system. Students Studying Abroad Students who are currently studying abroad and are expected to return and attend a PPS school during the current school year may be admitted into Synergy for tracking purposes. 1. Enroll the student into Synergy with the NS:Extended Leave enter code. 2. School may assign the student to courses in Synergy. Teen Parent Services See Maternity Leave on page 7 10

Transfers from Out-of-District (Inter-district transfers) For the 2013-14 school year, non-resident students may attend District schools if they obtain an Interdistrict Transfer from their resident school district and are approved by the administrator of the requested PPS school. Portland district students must be given first consideration for available slots when the process is initiated. Inter-district agreements must be renewed annually. Renewal will be coordinated by ETC. The Portland School District does receive state funding for inter-district transfer students. If a PPS student moves to a non-resident district during the school year and wishes to continue attending the enrolled school, an inter-district agreement must be secured. To report a Non-Resident Student, log in to School Choice Admin Tools online, go to the Non-Resident Manager, and enter the appropriate information. Continued enrollment in a PPS school is based on academic progress, attendance, behavior, and space available. A Clearance for Registration will be issued if PPS and the non-resident district approve the interdistrict transfer. 1. Verify the student has Clearance for Registration form from ETC. Approval is required each year. 2. Enroll the student into Synergy following the standard enrollment process. 3. On the Enrollment screen the Status field must be Resident and the Legal District of Residence field must be the district where the student lives. 4. The Effective Date is the student s first day of enrollment after approval. Transfers within the District (intra-district transfer) School Choice Transfer Process The School Choice transfer process offers a wide variety of educational options that meet the learning needs and educational interests of all students. The goal is to provide all families with the opportunity to apply for transfer through a system that promotes equal access and diversity by minimizing barriers to participation. Information for families, training sessions for school staff and community outreach are now being scheduled for the 2014-2015 transfer cycle. This information along with the School Choice process will be available online at http://www.pps.k12.or.us/departments/enrollment-transfer/schoolchoice.htm. The PPS School Choice lottery is a centrally operated, computerized software program created to place students applying for transfer into available schools and programs. Lottery results are sent by mail to families, six to eight weeks after the School Choice lottery application deadline. The step-by-step lottery process, including rules and requirements, is available on the School Choice website. Focus Option programs, Language Immersion programs and Fee-for-Service Kindergarten programs have placement requirements (e.g. language proficiency, statement of understanding, tuition). Before the lottery is run, School Administrators use the Lottery Application Manager in School Choice Admin Tools to indicate whether students meet requirements and are eligible for lottery placement. Students who do not meet requirements are not considered for placement to that program. 1. Verify the student has an approved transfer by checking School Choice Admin Tools and verify Status is Approved for the current school year. 2. Enroll the student in Synergy following the standard enrollment process. 11

Tuition Based Enrollment Non-Residents Non-resident families (including those living in Washington) may elect to pay tuition for their student to attend a district school upon approval of the requested school administrator. Tuition agreements are made for non-resident students in situations where a student does not obtain an inter-district transfer for full or part-time enrollment in PPS. First priority is given to district students. For non-resident students in Full-Day Fee-for-Service Kindergarten programs, half of the tuition must be paid by families (as with resident students) while the remaining half requires an agreement with the resident district for release of state school funds. ETC manages the inter-district transfers and. Schools manage the program fees for Fee-For-Service Kindergarten. See Appendix E for Fee-For-Service information. Non-resident families may elect to remain in full-day Kindergarten programs in Title I schools free of charge by securing an inter-district transfer. Tutoring Students Receiving & Not Receiving Special Education Services Students who are unable to attend school for medical or safety reasons and are receiving tutoring from a licensed teacher. A student s enrollment can be counted for state ADM only if they are receiving at least one hour of tutoring per day from a licensed teacher. NOTE: Providing homework does NOT constitute as tutoring, see Medical/Safety Leave. 1. The home school enrolls the student with the NS: Homebound, Receiving Tutoring enter code. 2. Track the email the instructional hours to sis@pps.net on a quarterly basis. Contact Information If you have SIS enrollment questions, please call the IT Service Desk at (503) 916-3375 and select option 2. If you have questions or concerns about information in this handbook that is not technology related, please contact the Enrollment and Transfer Center at (503) 916-3205. 12

APPENDIX A Portland Public Schools: Policies and Administrative Directives

4.10.020-P Age At Entrance

ADMINISTRATIVE DIRECTIVE 4.10.033-AD Early Entry into Kindergarten and First Grade A. Introduction: In accordance with board Policy 4.10.032-P, early entry is granted for an intellectually and /or academically advanced child who would not otherwise be allowed to enter kindergarten or first grade for another year due to their date of birth. B. Early Entry Into Kindergarten: 1. Students whose fifth birthday occurs after September 1 st and on or before October 1 st may apply for Early Entry into Kindergarten. All applications for Early Entry must be received by the Talented and Gifted [TAG] Office by September 15 th. 2. Process: The TAG Office will make the final determination to accept a student for Early Entry based on the following criteria: (a) (b) (c) (d) (e) (f) (g) C. Early Entry Into First Grade: test scores; an intelligence quotient at or above the 95 th percentile the child s preschool history and experiences the child is in good health and free of emotional problems eye-hand coordination should suggest at least average perceptual-motor skills evident reading readiness, if not reading ability verbal and quantitative reasoning merit weight since these abilities appear central to school success observational and interview findings of the principal. 1. Students whose sixth birthday occurs after September 1 st and on or before October 1 st may apply for Early Entry into First Grade. All applications for Early Entry must be received by the TAG Office by September 15 th. 2. Process: The TAG Office will make the final determination to accept a student for Early Entry based on the following criteria: Portland Public Schools Page 1 of 2 3/5/2009

EARLY ENTRY FOR KINDERGARTEN AND FIRST GRADE 4.10.033-AD (a) (b) (c) (d) (e) (f) (g) test scores; performance in reading and math at or above the 95 th percentile on the Iowa Test of Basic Skills the child s preschool history and experiences; the child is in good health and free of emotional problems; eye-hand coordination should suggest at least average perceptual-motor skills; verbal and quantitative reasoning merit weight since these abilities appear central to school success; observational and assessment findings of kindergarten teacher, preschool teacher, and parents; observational and interview findings of principal. Policy Implemented: 4.10.032-P History and Reference: Adpt. 3/09 Portland Public Schools 3/5/2009 Page 2 of 2

4.10.040-P Admission of Nonresident Students

4.10.041-AD Tuition Information

ADMINISTRATIVE DIRECTIVE 4.10.047-AD Residency & Neighborhood School Assignment I. Introduction A. Students shall attend the neighborhood school in the attendance area where they reside with their parent, guardian or other supervising adult, unless they: 1. Have an approved transfer, 2. Are assigned to another school (see Section VI), 3. Are an emancipated minor, or 4. Are otherwise exempt from compulsory enrollment laws (see 4.10.010-P). B. Students who qualify as homeless under the Federal McKinney-Vento Act are not required to provide proof of supervision or residency in order to enroll in school. II. Definitions A. Guardian means a person entrusted by law with the care of a child. B. Supervising adult means an adult in a parental relationship who has physical custody of a child or resides in the same household as a child, interacts with the child daily, provides the child with food, clothing, shelter and incidental necessities and provides the child with necessary care, education and discipline, pursuant to ORS 339.133(8)(a). It does not mean a person with a power of attorney or other written delegation of parental responsibilities if the person does not have other evidence of a parental relationship. C. Transfer means a formal request by a District family for a student to attend a school or program other than his/her neighborhood school or to return to his/her neighborhood school from a transfer school (see 4.10.051-P and 4.10.054-AD). D. Emancipated minor means a person who has been so declared by the courts pursuant to ORS Chapter 419B or similar out-of-state statute. E. Supervision agreement means an agreement in which an adult who is not the parent or legal guardian of a student assumes responsibility for that student for the purposes of educational and residency decisions. F. Neighborhood school means a school serving a designated attendance area within a school district and as defined in 6.10.022-P. Portland Public Schools Page 1 of 4

Residency & Neighborhood School Assignment 4.10.047-AD G. Attendance area means a geographic area served by an individual school. H. Student s residence means the place where a student eats, sleeps and otherwise lives with some degree of permanency with the student s parent, guardian or other supervising adult. Owned, leased or rented secondary domiciles or other property, or places of business apart from primary residences, and addresses designed only for receipt of U.S. mail, do not constitute a place of residence. III. Residency A. Students are considered residents of the attendance area where they live with: 1. A parent, 2. A guardian, 3. A substitute care provider, including a foster care and court-appointed provider, as provided in ORS Chapter 339, or 4. A supervising adult who has obtained a Supervision Agreement from the Enrollment and Transfer Center (ETC) due to a hardship circumstance. B. Students whose parents are separated or divorced are considered residents of the attendance area in which their custodial parent resides. C. Students who are considered to have reached the age of majority through becoming 18 years of age or older, marriage or being legally emancipated minors are considered residents of the attendance areas in which they reside. IV. Proof of Residency A. Proof of residency is necessary to determine the correct school district, as required by ORS Chapter 339, and neighborhood school assignment for each student. B. Two current documents reflecting the student s residence shall be provided to the school or ETC staff prior to student enrollment. Proof of residency documents include: 1. Utility bills, such as phone, electricity, natural gas or water, 2. Real estate documents, such as a rent receipt or lease agreement with the name of the tenant and landlord and contact information, mortgage statement or real estate closing statement, 3. Insurance statement, such as automobile, home, rental or health, Portland Public Schools Page 2 of 4

Residency & Neighborhood School Assignment 4.10.047-AD 4. Financial documents, including bank statement, credit card statement or pay stub, and 5. Government documents, including state or federal tax return, social security statement, unemployment insurance, WIC or Oregon Health Plan statement. C. If a parent, guardian or supervising adult cannot provide proof of residency due to a recent move or change in family situation, a temporary Declaration of Residency may be issued allowing a student to attend school for 10 school days while the family obtains the necessary documents. School enrollment may be terminated after the tenth day of attendance if residency has not been established. D. Current proof of residency documents may be requested at any time by school or ETC staff if there is reasonable cause to believe that the student s residency information is incorrect. E. Falsification or misrepresentation of an address, residence or living arrangement to obtain a school assignment may result in revocation of the student s current school assignment and return to the correct school. V. Students Who Move A. When students move from one school attendance area to another within the District: 1. Students who want to attend their new neighborhood school shall be admitted with appropriate documentation: a) Verification of their new residence address, b) Students who have transferred into their current school must obtain transfer releases from the ETC. 2. Students may remain in their currently enrolled school to the highest grade. a) Transportation is the responsibility of the family. b) Upon completion of the highest grade, students will be assigned to the next school level based on their new address, unless they have received an approved transfer to another school. 3. Students who remain in their currently enrolled school retain the right to attend their new neighborhood school at a later time, so long as they meet the documentation requirements listed above. Portland Public Schools Page 3 of 4

Residency & Neighborhood School Assignment 4.10.047-AD a) A change to the new neighborhood school does not require approval if made during natural school breaks, such as between semesters or school years. b) Students who wish to begin attending their new neighborhood school at other times of the school year must use the petition transfer process (4.10.054-AD). B. When students move to another school district, their parent or supervising adult shall inform their current principal. The principal shall submit a Nonresident Report Form to the ETC for any student who moves out of the District. 1. Students may remain in their currently enrolled school if: a) The new school district is in Oregon and has granted the student an inter-district transfer (see 4.10.040-P), or b) The parent, guardian, supervising adult or another entity has agreed to pay tuition (see 4.10.041-AD). VI. School Assignment Other Than Neighborhood School A. Students may be assigned to a school other than their neighborhood school with: 1. An approved transfer 2. A plan and placement for special program services which include, but are not limited to: a) Special education, b) English as a second language, c) Alternative education (Education Options), or d) Post-disciplinary action. Policy Implemented: 4.10.045-P Legal References: ORS 339.133-.134; ORS Chapter 419B History: Replaces 4.10-045-AD (Minors Not Living With Parents Or Guardians), 4.10.056-AD (Families Who Move); Adpt. 8/09 Portland Public Schools Page 4 of 4

4.10.051-P Student Enrollment and Transfers

ADMINISTRATIVE DIRECTIVE 4.10.047-AD Residency & Neighborhood School Assignment I. Introduction A. Students shall attend the neighborhood school in the attendance area where they reside with their parent, guardian or other supervising adult, unless they: 1. Have an approved transfer, 2. Are assigned to another school (see Section VI), 3. Are an emancipated minor, or 4. Are otherwise exempt from compulsory enrollment laws (see 4.10.010-P). B. Students who qualify as homeless under the Federal McKinney-Vento Act are not required to provide proof of supervision or residency in order to enroll in school. II. Definitions A. Guardian means a person entrusted by law with the care of a child. B. Supervising adult means an adult in a parental relationship who has physical custody of a child or resides in the same household as a child, interacts with the child daily, provides the child with food, clothing, shelter and incidental necessities and provides the child with necessary care, education and discipline, pursuant to ORS 339.133(8)(a). It does not mean a person with a power of attorney or other written delegation of parental responsibilities if the person does not have other evidence of a parental relationship. C. Transfer means a formal request by a District family for a student to attend a school or program other than his/her neighborhood school or to return to his/her neighborhood school from a transfer school (see 4.10.051-P and 4.10.054-AD). D. Emancipated minor means a person who has been so declared by the courts pursuant to ORS Chapter 419B or similar out-of-state statute. E. Supervision agreement means an agreement in which an adult who is not the parent or legal guardian of a student assumes responsibility for that student for the purposes of educational and residency decisions. F. Neighborhood school means a school serving a designated attendance area within a school district and as defined in 6.10.022-P. Portland Public Schools Page 1 of 4

Residency & Neighborhood School Assignment 4.10.047-AD G. Attendance area means a geographic area served by an individual school. H. Student s residence means the place where a student eats, sleeps and otherwise lives with some degree of permanency with the student s parent, guardian or other supervising adult. Owned, leased or rented secondary domiciles or other property, or places of business apart from primary residences, and addresses designed only for receipt of U.S. mail, do not constitute a place of residence. III. Residency A. Students are considered residents of the attendance area where they live with: 1. A parent, 2. A guardian, 3. A substitute care provider, including a foster care and court-appointed provider, as provided in ORS Chapter 339, or 4. A supervising adult who has obtained a Supervision Agreement from the Enrollment and Transfer Center (ETC) due to a hardship circumstance. B. Students whose parents are separated or divorced are considered residents of the attendance area in which their custodial parent resides. C. Students who are considered to have reached the age of majority through becoming 18 years of age or older, marriage or being legally emancipated minors are considered residents of the attendance areas in which they reside. IV. Proof of Residency A. Proof of residency is necessary to determine the correct school district, as required by ORS Chapter 339, and neighborhood school assignment for each student. B. Two current documents reflecting the student s residence shall be provided to the school or ETC staff prior to student enrollment. Proof of residency documents include: 1. Utility bills, such as phone, electricity, natural gas or water, 2. Real estate documents, such as a rent receipt or lease agreement with the name of the tenant and landlord and contact information, mortgage statement or real estate closing statement, 3. Insurance statement, such as automobile, home, rental or health, Portland Public Schools Page 2 of 4

Residency & Neighborhood School Assignment 4.10.047-AD 4. Financial documents, including bank statement, credit card statement or pay stub, and 5. Government documents, including state or federal tax return, social security statement, unemployment insurance, WIC or Oregon Health Plan statement. C. If a parent, guardian or supervising adult cannot provide proof of residency due to a recent move or change in family situation, a temporary Declaration of Residency may be issued allowing a student to attend school for 10 school days while the family obtains the necessary documents. School enrollment may be terminated after the tenth day of attendance if residency has not been established. D. Current proof of residency documents may be requested at any time by school or ETC staff if there is reasonable cause to believe that the student s residency information is incorrect. E. Falsification or misrepresentation of an address, residence or living arrangement to obtain a school assignment may result in revocation of the student s current school assignment and return to the correct school. V. Students Who Move A. When students move from one school attendance area to another within the District: 1. Students who want to attend their new neighborhood school shall be admitted with appropriate documentation: a) Verification of their new residence address, b) Students who have transferred into their current school must obtain transfer releases from the ETC. 2. Students may remain in their currently enrolled school to the highest grade. a) Transportation is the responsibility of the family. b) Upon completion of the highest grade, students will be assigned to the next school level based on their new address, unless they have received an approved transfer to another school. 3. Students who remain in their currently enrolled school retain the right to attend their new neighborhood school at a later time, so long as they meet the documentation requirements listed above. Portland Public Schools Page 3 of 4

Residency & Neighborhood School Assignment 4.10.047-AD a) A change to the new neighborhood school does not require approval if made during natural school breaks, such as between semesters or school years. b) Students who wish to begin attending their new neighborhood school at other times of the school year must use the petition transfer process (4.10.054-AD). B. When students move to another school district, their parent or supervising adult shall inform their current principal. The principal shall submit a Nonresident Report Form to the ETC for any student who moves out of the District. 1. Students may remain in their currently enrolled school if: a) The new school district is in Oregon and has granted the student an inter-district transfer (see 4.10.040-P), or b) The parent, guardian, supervising adult or another entity has agreed to pay tuition (see 4.10.041-AD). VI. School Assignment Other Than Neighborhood School A. Students may be assigned to a school other than their neighborhood school with: 1. An approved transfer 2. A plan and placement for special program services which include, but are not limited to: a) Special education, b) English as a second language, c) Alternative education (Education Options), or d) Post-disciplinary action. Policy Implemented: 4.10.045-P Legal References: ORS 339.133-.134; ORS Chapter 419B History: Replaces 4.10-045-AD (Minors Not Living With Parents Or Guardians), 4.10.056-AD (Families Who Move); Adpt. 8/09 Portland Public Schools Page 4 of 4

4.10.056-AD Families Who Move

APPENDIX B State Laws Regarding School Enrollment

Oregon State Law: Chapter 339, Sections Regarding School Enrollment 339.010 School attendance required; age limits. Except as provided in ORS 339.030, all children between the ages of 7 and 18 years who have not completed the 12th grade are required to attend regularly a public full time school of the school district in which the child resides. 339.020 Duty to send children to school. Except as provided in ORS 339.030, every person having control of any child between the ages of 7 and 18 years who has not completed the 12th grade is required to send such child to and maintain such child in regular attendance at a public full time school during the entire school term. 339.030 Exemptions from compulsory school attendance; rules. (1) In the following cases, children may not be required to attend public full time schools: (a) Children being taught in a private or parochial school in the courses of study usually taught in grades 1 through 12 in the public schools and in attendance for a period equivalent to that required of children attending public schools in the 1994 1995 school year. (b) Children proving to the satisfaction of the district school board that they have acquired equivalent knowledge to that acquired in the courses of study taught in grades 1 through 12 in the public schools. (c) Children who have received a high school diploma. (d) Children being taught for a period equivalent to that required of children attending public schools by a private teacher the courses of study usually taught in grades 1 through 12 in the public school. (e) Children being educated in the children s home by a parent or legal guardian. (f) Children excluded from attendance as provided by law. (2) The State Board of Education by rule shall establish procedures whereby, on a semiannual basis, an exemption from compulsory attendance may be granted to the parent or legal guardian of any child 16 or 17 years of age who is lawfully employed full time, lawfully employed part time and enrolled in school, a community college or an alternative education program as defined in ORS 336.615. An exemption also may be granted to any child who is an emancipated minor or who has initiated the procedure for emancipation under ORS 419B.550 to 419B.558. 339.035 Teaching by private teacher, parent or guardian; notice; examination; rules; effect of low or declining score. (1) As used in this section, education service district means the education service district that contains the school district of which the child is a resident. (2) When a child is taught or is withdrawn from a public school to be taught by a parent, legal guardian or private teacher, as provided in ORS 339.030, the parent, legal guardian or private teacher must notify the education service district in writing. In addition, when a child who is taught by a parent, legal guardian or private teacher moves to a new education service district, the parent, legal guardian or private teacher shall notify the new education service district in writing. The education service district shall acknowledge receipt of any notification in writing. 339.115 Admission of students; waiver; denial. (1) Except as provided in ORS 339.141, authorizing tuition for courses not part of the regular school program, the district school board shall admit free of charge to the schools of the district all persons between the ages of 5 and 19 who reside within the school district. A person whose 19th birthday occurs during the school year shall continue to be eligible for a free and appropriate public education for the remainder of the school year. A district school board may admit nonresident persons, determine who is not a resident of the district and fix rates of tuition for nonresidents. (2)(a) A district must admit an otherwise eligible person who has not yet attained 21 years of age prior to the beginning of the current school year if the person is: (A) Receiving special education and has not yet received a high school diploma as described in ORS 329.451 (1); or (B) Receiving special education and has received a modified high school diploma or alternative certificate as described in ORS 329.451.

(b) A district may admit an otherwise eligible person who is not receiving special education and who has not yet attained 21 years of age prior to the beginning of the current school year if the person is shown to be in need of additional education in order to receive a high school diploma. (3) The obligation to make a free appropriate public education available to individuals with disabilities 18 through 21 years of age who are incarcerated in an adult correctional facility applies only to those individuals who, in their last educational placement prior to their incarceration in the adult correctional facility: (a) Were identified as being a child with a disability as defined in ORS 343.035; or (b) Had an individualized education program as described in ORS 343.151. (4) For purposes of subsection (3) of this section, adult correctional facility means: (a) A local correctional facility as defined in ORS 169.005; (b) A regional correctional facility as defined in ORS 169.620; or (c) A Department of Corrections institution as defined in ORS 421.005. (5) An otherwise eligible person under subsection (2) of this section whose 21st birthday occurs during the school year shall continue to be eligible for a free appropriate public education for the remainder of the school year. (6) The person may apply to the board of directors of the school district of residence for admission after the 19th birthday as provided in subsection (1) of this section. A person aggrieved by a decision of the local board may appeal to the State Board of Education. The decision of the state board is final and not subject to appeal. (7) Notwithstanding ORS 339.133 (1), a school district shall not exclude from admission a child located in the district solely because the child does not have a fixed place of residence or solely because the child is not under the supervision of a parent, guardian or person in a parental relationship. (8) Notwithstanding subsection (1) of this section, a school district: (a) May for the remaining period of an expulsion deny admission to the regular school to a resident student who is expelled from another school district; and (b) Shall for at least one calendar year from the date of the expulsion and if the expulsion is for more than one calendar year, may for the remaining period of time deny admission to the regular school program to a student who is under expulsion from another school district for an offense that constitutes a violation of a school district policy adopted pursuant to ORS 339.250 (6). (9) A child entering the first grade during the fall term shall be considered to be six years of age if the sixth birthday of the child occurs on or before September 1. A child entering kindergarten during the fall term shall be considered to be five years of age if the fifth birthday of the child occurs on or before September 1. However, nothing in this section prevents a district school board from admitting free of charge a child whose needs for cognitive, social and physical development would best be met in the school program, as defined by policies of the district school board, to enter school even though the child has not attained the minimum age requirement but is a resident of the district. 339.125 Admission of nonresident pupils; costs. (1) The district school board may contract with the district school board of any other district for the admission of pupils in schools of the other district. The contract shall be in writing upon forms furnished by the Department of Education. Expense incurred shall be paid out of the school funds of the district sending such pupils. If the district sending the pupils fails to pay the expense so incurred according to the terms of the contract, the administrative office for the county containing such school district, after satisfactory proof of such failure, shall deduct the amount of the unpaid expense from the amount due the school district at the next regular apportionment. The county treasurer shall pay the amount of the reduced apportionment out of the county school fund. (2) In case the school district sending the pupils is a joint district, jurisdiction shall be exercised by the administrative office for the county in which the most populous part of such district is situated, according to the latest school census. The office s action in the matter is final.

339.129 Education for children in local or regional correctional facilities required; funding; notice to district; access. (1) A school district shall provide or cause to be provided appropriate education for children placed in a local or regional correctional facility located in the school district. The education may be provided by the school district or an education service district. (2) The school district may claim State School Fund reimbursement under ORS 327.006 to 327.133, 327.348, 327.355, 327.357, 327.360 and 327.731 for each child who is in a local or regional correctional facility. (3) A local or regional correctional facility shall notify the school district within which the facility is located of the name and date of birth of each school age child placed in the facility, including a child with a disability under the age of 22 years who may be eligible for special education. The notice shall be in writing and shall be given within five business days of the child s placement in the facility. (4) The local or regional correctional facility shall allow the school district and education service district to have safe and reasonable access to children placed in that facility for whom the school district is required to provide education. (5) As used in this section: (a) Local correctional facility means a local correctional facility as defined in ORS 169.005. (b) Regional correctional facility means a regional correctional facility as defined in ORS 169.620. 339.133 Residency of student for school purposes; how determined; transportation of student. (1) Except as provided in subsection (3), (4), (5) or (7) of this section, children between the ages of 4 and 18 shall be considered resident for school purposes in the school district in which their parents, guardians or persons in parental relationship to them reside. (2) Non emancipated individuals between the ages of 4 and 18 living outside the geographic area of the school district for such reasons as attending college, military service, hospital confinement or employment away from home shall be considered resident in the district in which their parents, guardians or persons in parental relationship to them reside. (3) Individuals considered legally emancipated from their parents shall be considered resident in the district in which they actually reside, irrespective of the residence of their parents, guardians or persons in parental relationship. (4) Children placed by public or private agencies who are living in substitute care programs licensed, certified or approved shall be considered resident in the school district in which they reside by placement of the public or private agency. (5)(a) Notwithstanding subsection (4) of this section, when a juvenile court determines that it is in a child s best interest to continue to attend the school that the child attended prior to placement by a public agency, the child: (A) Shall be considered resident for school purposes in the school district in which the child resided prior to the placement; and (B) May continue to attend the school the child attended prior to the placement through the highest grade level of the school. (b) The public agency that has placed the child shall be responsible for providing the child with transportation to and from school when the need for transportation is due to the placement by the public agency. (c) Paragraph (b) of this subsection applies only to a public agency for which funds have been designated for the specific purpose of providing a child with transportation to and from school under this subsection. (6) Persons living temporarily in a school district for the primary purpose of attending a district school may not be considered legally resident of the district in which they are living temporarily, but shall be considered resident in the district in which they, their parents, guardians or persons in parental relationship to them maintain residency. (7) Except as provided in ORS 327.006 (7) and 335.090, persons whose legal residence is not within the district but who attend school in the district with the written consent of the affected district school boards

shall be considered to be residents of the district in which the person attends school for purposes of the receipt by that district of State School Fund moneys for the person. (8) For the purposes of this section: (a) Person in parental relationship means an adult who has physical custody of a child or resides in the same household as the child, interacts with the child daily, provides the child with food, clothing, shelter and incidental necessaries and provides the child with necessary care, education and discipline. Person in parental relationship does not mean a person with a power of attorney or other written delegation of parental responsibilities if the person does not have other evidence of a parental relationship. (b) Substitute care program means family foster care, family group home care, parole foster care, family shelter care, adolescent shelter care and professional group care. 339.134 Residency of child with disability. (1) Notwithstanding ORS 339.133 (4), a child with a disability shall be considered a resident for school purposes in the school district in which the child s parent or guardian resides if: (a) The child is voluntarily placed outside the child s home by the child s parent or guardian; (b) The child s parent or guardian retains legal guardianship of the child; (c) There is a plan for the child to return home; (d) The placement is within 20 miles by the nearest traveled road from the original school building, unless there are physiographic conditions that make transportation to the original school building not feasible; and (e) The child s parent or guardian and the school staff can demonstrate that it is in the best interest of the child to continue to attend the school the child was attending prior to the placement. The best interest of the child may be demonstrated by factors, including but not limited to the following: (A) The child s siblings attend the school; (B) A change in the child s routine would be detrimental to the child; or (C) The child has developed and maintained a network of personal contacts, support services and friends and a sense of community within the school. (2) If a child qualifies under subsection (1) of this section, the child may continue to attend the school the child was attending prior to the placement in the child s resident school district. (3) Nothing in this section shall affect the ability of school districts to enter into agreements with other school districts for the transportation of students. 339.137 Residency of student at youth care center. (1) A student described in ORS 336.580 shall be considered a resident of the school district in which the student resides by reason of the placement under ORS 336.580 for purposes of distribution of the State School Fund. (2) A student described in subsection (1) of this section must be admitted to the public schools of the school district where the student is placed pursuant to ORS 336.580. (3) Except as provided in ORS 343.261, 343.961 and 346.010, the school district shall provide or cause to be provided appropriate education to any student described in subsection (1) of this section, including the identification and evaluation of the student for purposes of determining eligibility as a child with a disability to receive special education and related services enumerated in ORS 343.035 and services related to a disadvantaged child as defined in ORS 343.650. Suspension or expulsion of a student from the regular school program does not relieve the district of the obligation to provide instruction in the residential program in which the child resides or in another appropriate facility.

APPENDIX C Enrollment and Transfer Center Forms, Guidelines & Letters

Welcome to PPS Enrollment Information Letter

Declaration of Residency Memo

Resident Relocation Guidelines

Resident Relocation Form

Non-Resident Student Guidelines

Non-Resident Student Form

School Choice Administration Admin Tools

APPENDIX D DHS Senate Bill 414 Information

DHS Senate Bill 414 Information What the Senate Bill 414 Does: 1. Requires the Department of Human Services (DHS) to make diligent efforts to place siblings together when siblings are removed from the home and placed in foster care, residential care or group care unless such a placement is not in the best interest of the children. 2. Requires DHS to report to the court on these efforts. 3. Recognizes as a matter of state policy the importance of a child's relationship with parents, siblings and other relatives. 4. Requires a court to make written findings when a child is removed from the home concerning whether DHS made diligent efforts to place the child with a relative. Allows a court to order visitation by the ward's parents and siblings with the child or children removed from the home and placed in foster care. 5. Requires DHS to report to the court information on school attendance and school progress, face to face contacts of the assigned caseworker with a child in the guardianship or custody of DHS; and parent and sibling visits while a child has been in the guardianship or custody of DHS. 6. Also allows DHS to make federal foster care maintenance payments to for profit organizations. The law went into effect on January 1, 2008, and in Multnomah County, schools will begin receiving letters from DHS on May 1 st. A consortium of representatives from county school districts, DHS and MESD put together a process that we believe has the least day to day impact on a school staff and their workload, yet still complies with the law. When a school receives one of these letters from DHS, it is important to respond promptly and the best tools to use are the document titled "SB 414 Flow Chart" as well as the document titled "esis Procedure for Student in Custody of DHS". For General education students, the process is primarily an esis process in which the parent is changed to reflect "Social Services" and DHS Services are identified as well. One additional step is for the School 504 Coordinator to copy and send the 504 plan to the DHS worker assigned to the student. All other information needed by DHS will be culled from esis and sent to DHS in an electronic report (this will be done by the MESD, which coordinates esis services county wide). For SPED students, the process is somewhat different because there are additional forms to be shared with DHS (IEP s, Initial Evaluation Reports, etc.). In this case, the secretary will first send a notice to the foster parents (or other guardian of the student), whomever is currently listed as the parent. The purpose of this letter is to inform these individuals that records will be shared with DHS and if, for any reason, the individuals named want to oppose this release of records, they will know whom to contact to address their concern (the court). After six days, the secretary faxes the special education records request and court order to the Special Ed. Records room at 503 916 3018. If you receive a letter and have questions, please call Student Services at 503 916 5460.

DHS Student Education Records Protocol Flow Chart

Parental Notice Template for Sped Students Only

SB 414 Memo of Understanding

Synergy Reference Guide G7 Senate Bill 414 Once the school has received a letter from the Department of Human Services indicating a student is in the legal custody of the State of Oregon, the school needs to add a DHS case worker as a parent in Synergy. Assign an existing DHS Case Worker as a Parent Step 1 Go to: Synergy SIS>Student>Student>Parent/Guardian tab a. Enter search criteria it can be a combination of fields (i.e. Last Name, First Name, or Student ID). b. Click Find, or Enter on your keyboard. Step 2 Click Add to insert a blank row under Parents and Guardians. Step 3 Order: Enter the order number in which DHS should be contacted Lives With: Leave blank Relation: Select xexclusive Use Only DHS Srvcs. Parent Name: To add a new parent, click on the grey arrow to query for an existing parent or to add new (Go to Step 4). NOTE: If an existing parent/guardian is listed, click on the parent/guardian name to bring up the Parent screen in a separate window with more information about the person Type, Phone: The Type of primary phone to be used to contact the parent is shown with the number listed in the Phone column NOTE: These fields will populate when an existing parent is selected, or added new Contact Allowed: Check the box PVUE: Leave unchecked Mailings Allowed: Check the box Deceased: Leave unchecked Released To: Check the box Step 4 To query for a DHS case worker, click on the grey arrow under Parent Name. July 2013 Page 1 of 3 Published by: PPS IT Training

SYNERGY REFERENCE GUIDE SENATE BILL 414 PORTLAND PUBLIC SCHOOLS Step 5 a. The Find: Parent screen will open in a new window. Enter search criteria (e.g., Last Name, First Name or both). NOTE: To prevent creating duplicate parent records, try inputting part of the name (last or first) a broader list of names to select from will appear. Example: If the last name is hyphenated, instead of typing Garcia Martinez, type Garcia instead. Last names of Martinez Garcia and Garcia Martinez will appear. b. Click Find, or press Enter on your keyboard to display a list of names to choose from. Step 6 To select the case worker, click on the Line number and click Select, or double click on the Line number If the DHS case worker does not exist in Synergy, go to Page 3, Assign a New DHS Case Worker to a Student. July 2013 Page 2 of 3 Published by: PPS IT Training

SYNERGY REFERENCE GUIDE SENATE BILL 414 PORTLAND PUBLIC SCHOOLS Assign a New DHS Case Worker to a Student Step 1 Follow Steps 1 4 above. NOTE: These steps assume the DHS case worker is not in Synergy. Step 2 Click Add New Parent. Step 3 Type in the two required highlighted fields, Last Name, First Name. Click Save. Step 4 Step 5 The name will be inserted under Parent Name. Click on the name which is now a link it will open the Parent screen. NOTE: Maximize the window to view all of the fields at the bottom of the screen. If a field is not applicable, leave it blank. The parent/guardian s name is greyed out. If it needs to be modified, click on Menu > Edit Parent Data. If no changes, fill out the rest of the fields as per the Student Registration Form. A list of fields on the Parent screen include: Parent Info: Gender, Parent Email, Deceased indicator, Additional Info Home Address: Home Address, City State, Zip Code Phone Numbers: List and specify phone number(s) for the parent. Whichever number is specified as Primary will be used for mass communications, including attendance and emergency notifications. Additional Info: Willing to Volunteer, Live/Work Federal Property When done inputting information, click Save. FOR ASSISTANCE CONTACT THE IT SERVICE DESK, 503.916.3375 or itservicedesk@pps.net July 2013 Page 3 of 3 Published by: PPS IT Training

APPENDIX E Portland Public Schools Forms & Information

DESCC Referral Form

Fee-for-Service Kindergarten in Portland Public Schools All PPS K-5 and K-8 schools offer full-day kindergarten. The state of Oregon covers only the cost of half-day kindergarten. As a result, at this school the second half of the day is tuition-based and paid by parents. This is called fee-for-service kindergarten. Following is information about the fee-for-service kindergarten program. Tuition for full-day, fee-for-service kindergarten is $365 per month, September-May, or $3,285 for the school year. Tuition covers the cost of teachers, supplies, scholarships and administrative fees, and is nonrefundable. Payment plan options The program offers a varietyy of payment plan options, including: Automatic withdrawal from your account or charge debit or credit card Payment by personal check or payment in full at the beginning of the school year Individualized payment plan, such as smaller payments over a longer period Late payments The district takes late payments seriously. Parents who are late with payments receive a reminder letter with a new deadline. If payment is not sent by the deadline, the parent must pick up his/her child at the half-day dismissal time. To prevent this, we ask families to call Accounts Receivable to set up a payment plan. Financial aid Financial aid is available based on pre-tax (gross) family income. Families qualifying for the federal free and reduced-priced Families whose income is 250% of the poverty rate (about $ 4,800/month for a family of 4) or less are eligible to receive a 50% discount. meals program are eligiblee to receive a tuition waiver and do not pay tuition. Applications are available at the front office or at the kindergartenn website, link below. Contracts Every family with a child in full-day kindergarten completes a fee-for-service contract. Families enrolled in the neighborhood school complete the contract at registration. Transferr families complete the contract after approval in the lottery. On the contract, families indicate their choice of payment plan or financial aid. For financial aid requests, PPS will contact you in August with instructions to determine your eligibility. Half-day Because of high demand for full-day kindergarten, most schools do not offer separatee half-day classrooms. Instead, you may pick up your child from the full-day classroom at the half-day dismissal time. This optionn is typicallyy not available in immersion or focus option classrooms. Contact the school for details and visit the kindergarten website for more detailed information about half-day kindergarten. For more information about the fee-for-service or email nhauth@pps.net, or call 503-916-3230. Reminder: Register for kindergarten as soon as possible, and no later than May 1 to program, go to www.pps.net, click Departments then Kindergarten ensure that you get invited to spring and summer events at the school! Fee for Service Kindergarten 2013/14

CONTRACT for FULL-DAY, FEE-FOR-SERVICE KINDERGARTEN for the 2013-14 SCHOOL YEAR Welcome to the Full-Day, Fee-for-Service Kindergarten Program at Portland Public Schools ( District ). The District s Full-Day, Fee-for-Service Kindergarten ( Program ) provides Parents/Guardians the opportunity to enroll their student in a full-day kindergarten classroom while paying tuition only for the second half of the school day. Please read and sign this Contract, making sure to complete the information below and in Section 3 (Payment). For definitions and terms used in this Contract, please visit www.pps.k12.or.us/departments/kindergarten/1593.htm. We look forward to a great year for your student! School Name: Student Name: Parent/Guardian 1 Name: Address: City, ZIP: Telephone(s): Email address: Parent/Guardian 2 Name: Address: City, ZIP: Telephone(s): Email address: District and Parent/Guardian agree as follows: 1. Tuition and Financial Aid. A. Tuition Amount. For the 2013-14 School Year (September through May), tuition is $365/month (or $3,285/year). B. Financial Aid. Families qualifying for the Free and Reduced-priced Meals program ( FARM ) will receive full tuition waivers and need not pay tuition. Families who do not qualify for FARM and whose income is 250% or less of the federal poverty rate are eligible for a tuition discount. To learn more about the tuition waiver process and timeline, contact your school or visit www.pps.k12.or.us/departments/kindergarten. C. Tuition Payment Schedule. Payments are due by the 10th day of each month at the rate listed in Section 3. Parent/Guardian must select a payment method from the options in Section 3. D. Tuition Collection/Delinquency. Payments are considered past due on the 15th day of each month. District reserves the right to take appropriate action to collect tuition amounts in arrears. If the Parent/Guardian fails to make timely tuition payments, the consequences are as follows: E. For Neighborhood School Students: On the first school day following the 15th day of the second month of failing to pay tuition, your student will not be allowed to participate in the Program, though s/he may continue to attend the half-day kindergarten session at the school location. If the student is on transfer, the principal will decide if he/she may continue at the school in half-day kindergarten. Some schools require full-day participation. F. Non-refundable Tuition Payments. Tuition payments are non-refundable. District may cancel or terminate any and all services if deemed necessary by District. District may remove any student from the Program if tuition payment is in arrears. If you withdraw your student from the Program for any reason, the District is not obligated to refund any portion of the tuition payment for the month in which your student withdraws. However, District shall refund any tuition payments made for months beyond that month in which your student withdrew. 2. Fee-supported Program. This Program is fee-supported. If there are not enough tuition-paying families to cover its costs, District may discontinue the Program. If the Program is discontinued the above-listed school will offer only a Full-day Kindergarten, Page 1 of 2 012813

half-day, no-fee kindergarten program. District may increase or decrease tuition payments. District must notify Parent/Guardian in writing of any such adjustments at least 30 days before their effective date. 3. Payment. Parent/Guardian, please check either one box below the Tuition Options column, OR the Tuition Waiver box. Tuition Options Monthly Costs Number of Monthly Payments Total Method of Tuition Payment (forms attached) Full Tuition $365 9 (Sept. May) $3,285 Personal Check (no form needed) Tuition Discount (Application required; see also *** Tuition Discount Note below) $182.50 9 (Sept. May) $1,642.50 Credit Card (form) Auto Withdrawal (form) Paid in Full Tuition Waiver: Families approved for FARM (as measured by federal income guidelines published annually on July 1) are eligible for a tuition waiver. OR Families with children already attending school, foster children, or students who were approved for FARM in the 2012-13 school year may receive early approval for a tuition fee waiver; however, eligibility must be re-approved for the 2013-14 school year after July 1, 2013. Families new to the District (oldest child is enrolling in kindergarten) may check the above box to receive instructions for completing a FARM application after July 1, 2013. Family income may be 185% of the federal poverty rate or less ($3,554/month for a family of four). *** Tuition Discount Note: A family qualifies for a tuition discount if family income is 250% of the poverty rate (about $4,800/month for family of four) or below. To apply for a tuition discount, complete and attach to this Contract a Tuition Discount Form available at your school or at www.pps.k12.or.us/departments/kindergarten. 4. Termination. Either party may terminate this Contract with 30 days written notice to the other party. Student withdrawal will also terminate this Contract. In the unlikely event that District cannot offer fee-for-service, full-day kindergarten in the 2013-14 School Year, this Contract will automatically terminate. PARENT/GUARDIAN SIGNATURES DISTRICT SIGNATURE and CONTACT INFORMATION Parent/Guardian 1 Signature Gregory C. MacCrone, Deputy Clerk Date Parent/Guardian 2 Signature Date Date CONTACT INFORMATION: Nancy Hauth, Program Manager Portland Public Schools P.O. Box 3107 Portland, Oregon 97208-3107 T: 503.916.3230 nhauth@pps.net Full-day Kindergarten, Page 2 of 2 012813

CONTRATO para KINDERGARTEN de DIA COMPLETO con PAGO-POR-SERVICIO Para el AÑO ESCOLAR 2013-14 Bienvenidos al Programa de Kindergarten/Jardín de infantes de Día completo, con Pago-por-servicio, de las Escuelas Públicas de Portland ( El Distrito ). El Kindergarten de Día Completo con Pago-por-servicio del Distrito ( El Programa ) proporciona a los Padres/Tutores legales la oportunidad de inscribir a su estudiante en un salón de kindergarten/jardín de infantes de día completo pagando matrícula solamente por la segunda mitad del día escolar. Por favor lea y firme este Contrato, asegurándose de completar la información siguiente y en la Sección 3 (Pagos). Para las definiciones y terminología usadas en este Contrato, por favor visite el sitio Web www.pps.k12.or.us/departments/kindergarten/1593.htm. Esperamos un gran año para su estudiante! Nombre de la escuela: Nombre del estudiante: Nombre del Padre/Tutor legal 1: Nombre del Padre/Tutor legal 2: Dirección: Dirección: Ciudad/Código postal: Ciudad, Código postal: Teléfono(s): Teléfono(s): Correo electrónico: Correo electrónico: El Distrito y el Padre/Tutor legal acuerdan lo siguiente: 1. Matrícula y Ayuda financiera. A. Cantidad de la matrícula. Para el Año Escolar 2013-14 (de septiembre a mayo), la matrícula es de $365 al mes (o $3,285 al año). B. Ayuda Financiera. Las familias que califican para el Programa de Comida gratis o de precio reducido ( FARM por sus siglas en inglés) recibirán exención total de la matrícula y no necesitan pagar la matrícula. Las familias que no califican para el programa FARM y cuyos ingresos constituyen el 250% o menos de la tasa de pobreza federal son elegibles para un descuento de la matrícula. Para obtener más información sobre el proceso de exención de matrícula y las fechas, póngase en contacto con su escuela o visite www.pps.k12.or.us/departments/kindergarten. C. Calendario para los pagos de matrícula. Los pagos se deben hacer antes del 10 de cada mes en la cantidad estipulada en la Sección 3. El Padre/Tutor legal debe seleccionar un método de pago de las opciones en la Sección 3. D. Recolección de matrícula/pagos delincuentes. Los pagos se consideran atrasados el día 15 de cada mes. El Distrito se reserva el derecho de tomar medidas apropiadas para cobrar la cantidad que se debe de matrícula (todos los pagos atrasados). Si el Padre/Tutor legal falla en hacer los pagos de matrícula a tiempo, las consecuencias son las siguientes: E. Para los estudiantes que asisten a la escuela del vecindario: El primer día de escuela después del 15to día del segundo mes de no pagar matrícula, a su estudiante no se le permitirá participar en el Programa, aunque él o ella pueda continuar asistiendo a la sesión de medio día de kindergarten en las instalaciones de la escuela. Si el estudiante asiste a la escuela por medio de una transferencia, el director decidirá si él/ella puede continuar en la escuela en el kindergarten de medio día. En algunas escuelas es requisito la participación del día completo. F. Pagos de matrícula no reembolsables. Los pagos de matrícula no son reembolsables. El Distrito puede cancelar o dar por terminados cualquiera y todos los servicios si el Distrito lo considera necesario. El Distrito puede sacar Full-day Kindergarten, Page 1 of 3 012813

a cualquier estudiante del Programa si el pago de matrícula está atrasado. Si usted retira a su estudiante por cualquier razón, el Distrito no está obligado a devolverle ninguna porción del pago de matrícula del mes en el que se retire su estudiante. Sin embargo, el Distrito debe reembolsar cualquier pago de matrícula que se haya hecho para los meses más allá del mes en el cual se retiró el estudiante. 2. Programa sostenido con matrícula. Este programa es sostenido económicamente con los pagos. Si no hay suficientes familias que pagan matrícula para cubrir los costos, el Distrito puede descontinuar el Programa. Si el Programa es descontinuado, la escuela arriba mencionada ofrecerá solamente un programa de Kindergarten de medio día, sin pagos. El Distrito puede aumentar o disminuir los pagos de matrícula. El Distrito debe notificar a los Padres/Tutor legal por escrito de tales ajustes por lo menos 30 días antes de la fecha que entrarán en efecto. 3. Pagos. Padre/Tutor legal, por favor marque una de las casillas abajo en la columna titulada Opciones para la matrícula, O la casilla de Exención de matrícula. Opciones para la matrícula Costo mensual Número de pagos mensuales Total Método de pago de la matrícula (formularios adjuntos) Matrícula completa $365 9 (septiembre-mayo) $3,285 Cheque personal (no necesita formulario) Descuento de matrícula (Solicitud es requerida; ver también *** Nota sobre el Descuento de la Matrícula abajo) Exención de matrícula: $182.50 9 (septiembre-mayo) $1,642.50 O Tarjeta de crédito (formulario) Descuento automático (formulario) Pagado en su totalidad Las familias aprobadas para el Programa de Comida gratis y de precio reducido FARM -por sus siglas en inglés (según es medido por las normas federales de los ingresos publicadas anualmente el 1 ero de julio), son elegibles para una exención de matrícula. Las familias con niños que ya asisten a la escuela, niños que viven con familias de acogida, o los estudiantes que fueron aprobados para el Programa FARM en el año escolar 2012-13 pueden recibir aprobación anticipada para la exención de matrícula; sin embargo, la elegibilidad debe ser aprobada de nuevo para el año escolar 2013-14 después de julio 1 de 2013. Las familias que son nuevas en el Distrito (el hijo/hija mayor se está inscribiendo en kindergarten) pueden marcar esta casilla para recibir instrucciones para completar la solicitud para el Programa FARM después de julio 1 de 2013. Los ingresos de la familia pueden ser de un 185% de la tasa de pobreza federal o menos ($3,554 al mes para una familia de cuatro personas). *** Nota sobre el descuento de matrícula: Una familia califica para un descuento de la matrícula si los ingresos de la familia son el 250% de la tasa de pobreza (aproximadamente $4,800 al mes para una familia de cuatro personas) o menos. Para solicitar un descuento de matrícula, complete y adjunte a este contrato un Formulario para el descuento de matrícula disponible en su escuela o el en sitio Web www.pps.k12.or.us/departments/kindergarten. 4. Terminación. Cualquiera de los interesados (quienes firman este acuerdo) puede rescindir este Contrato con 30 días de notificación por escrito al otro partido. El retiro de un estudiante también terminará este Contrato. En el caso improbable que el Distrito no pueda ofrecer Kindergarten de día completo, con pago-por-servicio en al año escolar In 2013-14 este Contrato se cancelará automáticamente. FIRMA DE PADRE/TUTOR LEGAL FIRMA DEL DISTRITO e INFORMACIÓN DE CONTACTO Firma del Padre/Tutor legal 1 Full-day Kindergarten, Page 2 of 3 012813 Gregory C. MacCrone, Secretario

Fecha Firma del Padre/Tutor legal 2 Fecha Fecha INFORMACIÓN DE CONTACTO: Nancy Hauth, Administradora del programa Escuelas Públicas de Portland P.O. Box 3107 Portland, Oregon 97208-3107 T: 503.916.3230 nhauth@pps.net Full-day Kindergarten, Page 3 of 3 012813

Tuition Discount Application Fee-for Service Kindergarten This application is for families who do not meet the income criteria for the Free and Reduced-priced Meals program, but still need financial aid. The district provides a 50% tuition discount if a family s pre-tax income is less than 250% of the poverty rate (about $4,800/ month or less for family of 4). To determine if your family qualifies, please complete the form below and send to PPS, P.O. Box 3107, Portland OR 97208-3107 Attn: FFS Contracts or attach to your fee-for-service kindergarten contract and deliver to the front office of your school. We may ask you to supply documentation. School Name: Student Name: Parent/Guardian Name: Address: Daytime Phone: Email address (please write neatly): Best way(s) to contact you with results: Email U.S. Mail Phone call Number of people living in this household including you: Total monthly income before taxes are taken out (i.e. gross income): Is the student a foster child? (yes or no) Does your household receive SNAP or TANF support? (yes or no) By signing below, I certify that all information on this application is true and that all income is reported. We may ask you to supply documentation. Signature of Parent/Guardian Date Signed If you have questions about this form, please email nhauth@pps.net or call Nancy Hauth at 503-916-3230 For PPS use only: Request approved: Request denied: Note: To see if you qualify for a tuition waiver, ask the front office for the Tuition Waiver Process flyer or go online to pps.net, departments, kindergarten, full-day kindergarten. Partial Scholarship form 1/2013 Page 1

Portland Public Schools Fee-For-Service Kindergarten Program Authorization for Direct Payment From Checking or Savings Account for the 2013-14 School Year Automatic Direct Payment To be deducted on the 10th of each month beginning September 10, 2013 and ending May 10, 2014. Tuition is $365 per month. Annual tuition amount is $3,285. Note: Your signature is required below. Form will not be processed without a signature. ===================================================== School Student Name Full Name Address City/State/Zip Date Telephone No. E-Mail Address Attach a voided check Dollar amount to be withdrawn monthly, September through May $ Checking Account Number (Required) Routing Number (Required) Financial Institution Name Signature (Required) (Optional For Joint Account) Signature (Required) Full Name Address City/State/Zip Date Daytime phone(s): Please attach to contract. Contact: Accounts Receivable, 503-916-3005, accountsreceivable@pps.net 2013-14 school year

Portland Public Schools Fee-For-Service Kindergarten Program Authorization for Use of Visa/Mastercard for Payment of Tuition For the 2013-14 School Year Automatic Charge to Credit Card To be charged on the 10th of each month beginning September 10, 2013 May 10th, 2014. Tuition is $365 per month. Annual tuition amount is $3,285. Note: Your signature is required below. Form will not be processed without a signature. ===================================================== Student Name: Parent/Guardian Name: Billing Address: City, State, Zip: Phone: School: Date: E-mail address: IMPORTANT PLEASE FILL OUT AND RETURN ENTIRE FORM NOTE: VISA or Mastercard only Cardholder s Name: Cardholder s Email address if different from above: Credit Card Number: - - - Expiration Date*: Please write clearly to avoid errors Cardholder s Signature: (Required) *If expiration is 9/13 5/14, please contact us a month in advance to submit your new expiration date: 503-916-3005 Please attach to contract. Contact: Accounts Receivable 503-916-3005 or accountsreceivable@pps.net 2013-14 school year

Records Request Form

2013-14 Confidential Family Application for Free or Reduced-Price Meals Apply online at www.pps.net/departments/nutrition Frequently Asked Questions and Instructions for Applying Do I need to apply every year? Yes. Eligibility for free and reduced-price meals is only approved for one school year. In addition to free or reduced-price school meals, students may also be eligible for other benefits (see page 3 of the application). Should I fill out an application if I got a letter this school year saying my children are approved for free meals? Please carefully read the letter you got and follow the instructions. If you received an Eligibility Notification-Free Meal Benefits letter for one or more children in your household (but not all) call (503) 916-3402 and tell us the names of other students in your household. Do I need to fill out a separate application for each child? No. Use one Family Application for Free and Reduced-Price Meals for all students in your household. We cannot approve an application that is not complete, so be sure to fill out all required information (see checklist on page 4). Return the completed application to your school or mail to the district s central office: Portland Public Schools Nutrition Services, PO Box 3107, Portland OR 97208-3107 Who can get free meals? Children in households getting Supplemental Nutrition Assistance Program (SNAP) Benefits (formerly the Food Stamp Program), TANF or FDPIR can get free meals regardless of your income. Also, your children can get free meals if your household income is within the free limits on the Federal Income Guidelines. Can foster children get free meals? Yes, foster children that are under the legal responsibility of a foster care agency or court can get free meals. Any foster child in the household can get free meals regardless of income. Can homeless, runaway and migrant children get free meals? Yes. Please call (503) 916-3402 to see if your child(ren) qualify, if you have not been informed that they will get free meals. Who can get reduced-price meals? Your children can get low cost meals (40 cents per lunch) if your household income is within the reduced-price limits on the Federal Income Guidelines shown on page 2 of the application. If my child is eligible for free or reduced-price meal benefits, when will the meal benefits begin? Meal benefits for new applications cannot start until an application is approved. Please provide a lunch or money for a paid lunch until you receive notice that the application is approved. I get WIC. Can my child(ren) get free meals? This can only be determined by completing and submitting the enclosed application for meal benefits. Please fill out an application. My children receive Oregon Health Plan benefits. Can they get free meals? This can only be determined by completing and submitting the enclosed application for meal benefits. Please fill out an application. Will the information I give be checked? Yes. We may ask you to send written proof. If I don t qualify now, may I apply later? Yes. You may apply at any time during the school year. What if I disagree with the school district s decision about my application? You may ask for a hearing to review the decision by calling or writing to: Portland Public Schools Nutrition Services, PO Box 3107, Portland OR 97208-3107, Phone: (503) 916-3399. May I apply if someone in my household is not a U.S. citizen? Yes. You or your child(ren) do not have to be a U.S. citizen to qualify for free or reduced-price meals. Who should I include as members of my household? You must include all people living in your household, related or not (such as grandparents, other relatives or friends). You must include yourself and all children who live with you. Foster children may be included as household members. If you live with other people who are economically independent (for example, people you do not support, who do not share income with you or your children and who pay a pro-rated share of expenses), do not include them. What if my income is not always the same? List the amount that you normally get. For example, if you normally earn $1000 each month, but you missed some work last month and only got $900, put down that you earn $1000 per month. If you normally get overtime, include it, but not if you get it only sometimes. We are in the military; do we include our housing allowance? If you get an off-base housing allowance, it must be counted as income. However, if your housing is part of the Military Housing Privatization Initiative, do not include your housing allowance as income. My spouse is deployed to a combat zone. Is combat pay counted as income? Combat pay is excluded if it is received in addition to the service member s basic pay; because of the deployment; and not received before being deployed. My family needs more help. Are there other programs we might apply for? To find out how to apply for SNAP or other assistance benefits, call 2-1-1 or 1-800-SAFENET (723-3638).

. All students who were receiving free or reduced-price meal benefits at the end of last year must complete a NEW meal application for the 2013-14 school year. If benefits are denied or reduced when the NEW application is approved, families will receive 10 days notice before the change is made. Students who have not submitted a NEW application will be required to pay full price starting October 14 th. Did you know you can submit this application online at www.pps.net/departments/nutrition Instructions for Applying For Supplemental Nutrition Assistance Program, SNAP (formerly Food Stamps) OR Temporary Assistance for Needy Families (TANF) Households, do the following: Part 1: Complete Household information Part 2: List child(ren) s name, school, grade, birthday and mark the checkbox if they are a formally placed foster child in the family. Part 3: Give the name of the person in the household with benefits and their case number, Supplemental Nutrition Assistance Program (SNAP) benefits case number (A11-11-1111) or TANF (AA111 or AAA111) Part 4: Skip this part. Part 5: Sign the form. A Social Security Number is not necessary for a SNAP or TANF application. Part 6: Answer this question if you choose to. Part 7: Answer this question if you choose to. If you are applying for a FOSTER CHILD, follow these instructions: Part 1: Complete Household information Part 2: List child(ren) s name, school, grade, birthday and mark the checkbox if they are a formally placed foster child in the family. Part 3: Skip this part Part 4: Skip this part Part 5: Sign the form. A Social Security Number is not necessary for a Foster Child application. Part 6: Answer this question if you choose to. Part 7: Answer this question if you choose to. OR Complete a household application for the entire household including the foster child following instructions for All Other Households ALL OTHER HOUSEHOLDS, including WIC households, follow these instructions: Part 1: Complete Household information. Part 2: List child(ren) s name, school, grade, birthday and mark the checkbox if they are a formally placed foster child in the family. Part 3: Skip this part. Part 4: Follow these instructions to report total household income from last month. Column 1 - Name: List the first and last name of each person living in your household, related or not (such as grandparents, other relatives, or friends). You must include yourself, those children living with you but not attending school and children in school receiving regular income. Do not repeat children listed in part 2 unless they receive regular income. Attach another sheet of paper if you need to. Column 2 - Gross Monthly Income: Next to each person s name list each type of income received last month. For example, Monthly Income: List the gross income each person earned from work. This is not the same as take-home pay. Gross income is the amount earned before taxes and other deductions. The amount should be listed on your pay stub, or your boss can tell you. If your income is paid weekly, every 2 weeks or twice a month, follow the instructions on page 2 of the application. Column 3 - List the amount each person got last month from welfare, child support, alimony. Column 4 - List the amount each person got last month from pensions, retirement, Social Security. Column 5 - List the amount each person got last month from Worker s Compensation, unemployment, strike benefits, Supplemental Security Income (SSI), Veteran s benefits (VA benefits), disability benefits, regular contributions from people who do not live in your household, and ANY OTHER INCOME. Report net income for self-owned business, farm, or rental income. Next to the amount, write how often the person got it. Military Housing Privatization Initiative - do not include this housing allowance. Column 6 Check the box if the household member listed has no income. Part 5: An adult household member must sign the form and list the last four (4) numbers of his or her Social Security Number, or mark the box if he or she doesn t have one. Part 6: Answer this question if you choose to. Part 7: Answer this question if you choose to. USDA, the State of Oregon, and Portland Public Schools are equal opportunity providers.

Portland Public Schools Solicitud Familiar Confidencial 2012-13 Para Comidas Gratis Y De Precio Reducido Instrucciones para solicitar beneficios Debo completar una solicitud si este año escolar recibí una carta en la que me dicen que mis hijos están aprobados para recibir comidas gratis? Lea la carta que recibió detenidamente y siga las instrucciones. Si no recibió una carta para cada uno de los niños de su hogar, entonces debe completar una solicitud listando a todos los miembros de su hogar. Llame a 503.916.3402 si tiene preguntas. Es necesario llenar una solicitud para cada niño? No. Complete la forma para solicitar comidas gratis o a precio reducido. Use una solicitud para comidas gratis o a precio reducido para todos los estudiantes en su hogar. Asegúrese de llenar la solicitud con toda la información requerida ya que no podemos aprobar solicitudes incompletas. Devuelva la solicitud completa a: Portland Public Schools Nutrition Services, PO Box 3107, Portland OR 97208-3107 Quién puede recibir comidas gratis? Niños en hogares que reciben SNAP* o TANF y la mayoría de los menores bajo la supervisión de servicios sociales pueden recibir comidas gratis sin importar sus ingresos. También si su ingreso familiar está dentro de los límites de la Tabla Federal de Ingresos, sus niños pueden recibir comidas gratis. Pueden los niños bajo tutela temporaria recibir comidas gratis? Sí, los niños bajo tutela temporaria que están bajo la responsabilidad legal de una agencia de tutela temporaria o tribunal pueden recibir comidas gratis. Todos los niños bajo tutela temporaria del hogar pueden recibir comidas gratis independientemente del ingreso. Pueden los niños sin hogar, niños que han abandonado su hogar y niños emigrantes recibir comidas gratis? Si no le han informado que sus hijos recibirán comidas gratis, por favor comuníquese con: 503.916.3402 para verificar si sus hijos califican. Quién puede recibir comidas a precio reducido? Sus hijos pueden recibir comidas a precio reducido si su ingreso familiar está dentro de los límites de la Tabla Federal de Ingresos mostrada en esta solicitud. Si mi hijo es elegible para recibir beneficios de comidas gratis o a precio reducido, cuándo comenzarán los beneficios? Los beneficios de comidas para las solicitudes nuevas no pueden comenzar hasta que se apruebe la solicitud. Haga que su hijo lleve almuerzo o déle dinero para comprar uno hasta que reciba notificación de que se ha aprobado la solicitud. Recibo WIC. Puede(n) mi(s) hijo(s) obtener comidas gratis? Esto sólo se puede determinar completando y presentando la solicitud para beneficios de comidas que se adjunta. Sírvase completar una solicitud. Mis hijos reciben beneficios del Plan de Salud de Oregon. Pueden obtener comidas gratis? Esto sólo se puede determinar completando y presentando la solicitud para beneficios de comidas que se adjunta. Sírvase completar una solicitud. Será verificada la información que yo provea? Sí, nosotros podríamos pedirle que envíe prueba escrita de la información provista. Si yo no califico ahora puedo solicitar más tarde? Sí. Usted puede solicitar en cualquier momento durante el año escolar si el tamaño de su familia aumenta, sus ingresos disminuyen, o si comienza a recibir SNAP* o TANF. Si usted pierde su trabajo, sus niños podrían recibir comidas gratis o a precio reducido durante el tiempo que usted esté sin empleo. Qué pasa si no estoy de acuerdo con la decisión de la escuela con respecto a mi solicitud? Usted deberá hablar con los oficiales de la escuela. También podría solicitar una audiencia ya sea llamando o escribiendo a: Portland Public Schools Nutrition Services, PO Box 3107, Portland OR 97208-3107, Phone: 503.916.3399 Puedo solicitar aunque alguien en mi hogar no sea ciudadano americano? Sí. Ni usted ni sus niños necesitan ser ciudadanos americanos para recibir comidas gratis o a precio reducido. A quienes tengo que incluir como miembros de mi familia? Usted debe incluir a todas las personas que vivan en su hogar aunque no sean parientes suyos (por ejemplo, abuelos, otros parientes o amigos). Usted también debe incluirse a si mismo y a todos los niños que viven con usted. Se puede incluir a los niños bajo tutela temporaria como miembros de la familia. Si usted vive con otras personas que son económicamente independientes (por ejemplo, personas a quienes no mantiene, que no comparten ingresos con usted o sus hijos y que pagan una parte prorrateada de los gastos), no las incluya. Qué pasa si mi ingreso no es siempre igual? Anote la cantidad que usted recibe regularmente. Por ejemplo, si usted normalmente recibe $1000 al mes pero se ausentó al trabajo el mes pasado y solo recibió $900, anote que usted recibe $1000 al mes. Si usted generalmente cobra por horas extras de trabajo incluya esa cantidad, pero no es necesario incluirla si solo trabaja horas extras a veces. Estamos en las Fuerzas Armadas, incluimos nuestro subsidio para vivienda? Si recibe un subsidio para vivienda fuera de la base, debe contarlo como ingreso. Sin embargo, si su vivienda es parte del la Iniciativa de Privatización de Viviendas para Militares (Military Housing Privatization Initiative) no incluya el subsidio para vivienda como ingreso. Mi cónyuge ha sido enviado a una zona de combate. Se cuenta la paga de combate como ingreso?. La paga de combate está excluida si se recibe en adición a la paga básica de miembro en servicio; se recibe como resultado del envío del miembro a la zona de combate; y no se recibía antes del envío a la zona de combate. Mi familia necesita más ayuda. Hay otros programas en los que podamos participar? Para saber cómo solicitar el SNAP u otros beneficios de asistencia, comuníquese con la oficina de asistencia local 1-800-SAFENET (1-800-723-3638]. Si usted tiene otras preguntas, por favor llame al: 503.916.3402.

INSTRUCCIONES PARA SOLICITAR BENEFICIOS Para beneficios de SNAP (Programa de Asistencia de Suplementaria) U hogares con TANF, haga lo siguiente: Parte 1: Complete la información de las personas que viven en su hogar Parte 2: Liste el nombre, la escuela, el grado escolar y la fecha de nacimiento del niño o niños y marque la casilla si son niños formalmente colocados bajo tutela temporaria en la familia. Parte 3: Dé el nombre de la persona en el hogar que tiene beneficios y su número de caso beneficios (SNAP) (A11-11-1111) o TANF (AA1111 o AAA111). Parte 4: Saltee esta parte. Parte 5: Firme el formulario. No es necesario dar un Número de Seguro Social. Parte 6: Responda esta pregunta si lo desea. Parte 7: Responda esta pregunta si lo desea. Si está hacienda una solicitud para un NIÑO BAJO TUTELA TEMPORARIA, siga estas instrucciones: Use una solicitud separada para cada niño bajo tutela temporaria Parte 1: Complete la información de las personas que viven en su hogar. Parte 2: Liste el nombre, la escuela, el grado escolar y la fecha de nacimiento del niño o niños y marque la casilla si son niños formalmente colocados bajo tutela temporaria en la familia. Parte 3: Saltee esta parte Parte 4: Saltee esta parte. Parte 5: Firme el formulario. No es necesario dar un Número de Seguro Social. Parte 6: Responda esta pregunta si lo desea. Parte 7: Responda esta pregunta si lo desea. O Complete una solicitud del hogar para todo el hogar, incluido el niño bajo tutela temporaria, siguiendo las instrucciones para "Todos los otros hogares" TODAS LOS OTROS HOGARES, incluidos aquellos que reciben WIC, sigan estas instrucciones: Parte 1: Complete la información de las personas que viven en su hogar. Parte 2: Liste el nombre, la escuela, el grado escolar y la fecha de nacimiento del niño o niños y marque si es un niño bajo tutela temporaria. Parte 3: Saltee esta parte. Parte 4: Siga estas instrucciones para informar el ingreso total del hogar del mes pasado. Columna 1 Nombre: Liste el nombre y apellido de cada persona que vive en su hogar, emparentada o no (como abuelos, otros parientes o amigos). Inclúyase a sí mismo, a los niños que viven con usted pero que no asisten a la escuela y a los niños que están en la escuela que reciben un ingreso regular. No vuelva a listar a los niños que ya figuran en la parte 2, a menos que reciban ingresos regulares. Adjunte otra hoja si es necesario. Columna 2 Ingreso bruto mensual Al lado del nombre de cada persona, liste cada tipo de ingreso recibido el mes pasado. Por ejemplo, Ingreso Mensual Liste el ingreso bruto que ganó cada persona en el trabajo. Esto no es lo mismo que la paga que se lleva a la casa. El ingreso bruto es la cifra ganada antes de impuestos y otras deducciones. La cifra debe estar listada en su talón de pago o se la puede decir su jefe. Si su ingreso se paga semanalmente, cada 2 semanas o dos veces al mes, siga las instrucciones al dorso de la solicitud. Columna 3 Liste la cifra que obtuvo cada persona el mes pasado de asistencia social, manutención infantil y pensión alimenticia. Columna 4 Liste la cifra que obtuvo cada persona el mes pasado de pensiones, retiro y Seguro Social. Columna 5 - Liste la cifra que obtuvo cada persona el mes pasado de compensación laboral, seguro de desempleo, beneficios de huelga, Ingreso de Seguridad Suplementario (SSI), beneficios de Veteranos (Beneficios VA), beneficios por discapacidad, contribuciones regulares de personas que no viven en su casa y CUALQUIER OTRO INGRESO. Informe el ingreso neto de negocios o granjas propios o ingresos por renta. Al lado de la cifra, escriba la frecuencia con que la persona obtuvo ese ingreso. Si está en la Iniciativa Militar de Privatización de Vivienda no incluya este complemento para vivienda. Parte 5: Un miembro adulto del hogar debe firmar el formulario y listar los últimos cuatro (4) números de su Número de Seguro Social o marcar la casilla si no tiene uno. Parte 6: Responda esta pregunta si lo desea. Parte 7: Responda esta pregunta si lo desea. Esta institución es un proveedor que ofrece iqual oportunidad a todos

Are there NEW students on this application? yes no 2013-2014 CONFIDENTIAL FAMILY APPLICATION FOR FREE & REDUCED-PRICE MEALS NOTICE: If you received an ELIGIBILITY NOTIFICATION FREE MEALS from Portland Public Schools do not complete this application. See Application Instructions on back of form. 1 HOUSEHOLD INFORMATION Print name of person completing this application (Last name, First name) Name Print Mailing Address Apt # City State Zip 2 STUDENT INFORMATION Child s Name (Legal Last name, First name) 1. 2. 3. 4. 5. School Home Phone or Cell Phone (Circle One) Work Phone Number living in this household (Write names of all household members on part 2 and/or part 4 of this form) Grade (Optional) Birth Date (Optional) Check if Foster Child 3 BENEFITS If any member of your household receives SNAP or TANF, provide the name and case number of the member receiving benefits Name Column 1 List all household members, including children not attending school, and income. Do not include students listed in part 2, unless they receive regular income. (Last name, first name) 1. 2. 3. 4. SNAP TANF Case Number Go to Part 5 below Does this household receive FDPIR (Food Distribution on Indian Reservations) Yes (Go Part 5 and complete) 4 HOUSEHOLD MEMBERS & GROSS MONTHLY INCOME if not monthly, see back for conversions Column 2 Column 3 Column 4 Column 5 MONTHLY MONTHLY CHILD MONTHLY OTHER MONTHLY INCOME SUPPORT, PENSIONS, INCOME -Including (Total earnings & WELFARE, SOCIAL unemployment and wages before ALIMONY SECURITY, workers comp. deductions) RECEIVED RETIREMENT Column 6 Check if No Income 5 SIGNATURE, DATE and Last four numbers of SOCIAL SECURITY NUMBER (Adult must sign) I certify (promise) that all of the information on this application is true (correct) and that all income is reported. I understand that the school will get Federal funds based on the information I give. I understand that school officials may verify (check) the information. I understand that if I give purposely false information, my children may lose meal benefits and I may be prosecuted. Signature of Adult Household Member X Date Signed Month/day/year 6 RACIAL OR ETHNIC GROUP (OPTIONAL) Mark one ethnic identity: Mark one or more racial identities: Hispanic or Latino Asian Not Hispanic or Latino American Indian & Alaskan Native Native Hawaiian or Other Pacific Islander Social Security Number (See privacy statement on back) XXX-XX - Black or African American White, not of Hispanic origin Other I do not have a Social Security Number. I prefer all written correspondence in Spanish Vietnamese Russian Chinese Somali Other 7 I do not want my information shared with State children s health insurance programs. Sign here: I have a child (or children) who does not have any kind of health coverage neither private health insurance nor Oregon Health Plan/Healthy Kids. I am interested in free or reduced cost health coverage for at least one of my children. Yes No SCHOOL USE ONLY - DO NOT WRITE BELOW THIS LINE Total Income: Number in household: Date Withdrawn: Free based on: Reduced based on: Denied Reason: SNAP/TANF/FDPIR Foster child categorical household income income too high incomplete application household income Determining Official s Signature : Date Form 581-3514e-P (Rev. 04/13) Page 1 SEE IMPORTANT INFORMATION ON REVERSE SIDE

Application Instructions If your household receives SNAP, TANF or FDPIR, complete parts 1, 2, 3 and 5; parts 6 and 7 are optional. If you do not receive these benefits and your income is below the guidelines, complete parts 1, 2, 4 and 5; parts 6 and 7 are optional. If you are a household with a FOSTER CHILD, complete parts 1, 2, 4, and 5; parts 6 and 7 are optional. DETERMINING MONTHLY INCOME FOR EARNINGS & WAGES Monthly income for all household members must be reported in Part 4 of this application. Income means any money regularly received from work, child support, alimony, pensions, retirements, social security or any other source. Exclude student/school loans. Household members who are not paid monthly should change earnings into monthly income by doing the following: Household members who are paid every week: Multiply total earnings and wages for one pay period, before deductions, by 52. Then divide by 12. The resulting amount is the total monthly income. Household members who are paid every 2 weeks: Multiply total earnings and wages for one pay period, before deductions, by 26. Then divide by 12. The resulting amount is the total monthly income. Household members who are paid twice a month: Multiply total earnings and wages for one pay period, before deductions, by 24 then divide by 12. The resulting amount is the total monthly income. Household members who are seasonal workers or work less than 12 months: Project annual rate of income to accurately represent actual circumstances then divide by 12. The resulting amount is the projected monthly income. Note: Money received from a business or farm owned by you should be reported as "net income." Net Income is defined as the total income left after business and farm operating expenses are subtracted from gross receipts. FEDERAL INCOME GUIDELINES Your children may qualify at least for reduced-price meals if your household income falls within the limits of this chart. Reduced Price Meals Household Size Annual Monthly Twice Per Every Two Month Weeks Weekly -1-21,257 1,772 886 818 409-2- 28,694 2,392 1,196 1,104 552-3- 36,131 3,011 1,506 1,390 695-4- 43,568 3,631 1,816 1,676 838-5- 51,005 4,251 2,126 1,962 981-6- 58,442 4,871 2,436 2,248 1,124-7- 65,879 5,490 2,745 2,534 1,267-8- 73,316 6,110 3,055 2,820 1,410 For each additional family member add 7,437 620 310 287 144 PRIVACY STATEMENT - SOCIAL SECURITY NUMBERS and OTHER INFORMATION The Richard B. Russell National School Lunch Act requires the information on this application. You do not have to give the information but if you do not, we cannot approve your child for free or reduced-price meals. You must include the last 4 digits of the social security number of the adult household member who signs the application. The last 4 digits of the social security number is not required when you apply on behalf of a foster child or you list a Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) Program or Food Distribution Program on Indian Reservations (FDPIR) case number or other FDPIR identifier for your child or when you indicate that the adult household member signing the application does not have a social security number. We will use your information to determine if your child is eligible for free or reduced-price meals and for administration and enforcement of the lunch and breakfast programs. We may share your eligibility information with education, health, and nutrition programs to help them evaluate, fund, or determine benefits for their programs, auditors for program reviews, and law enforcement officials to help them look into violations of program rules. We may share the information on this form with Medicaid or the State Children s Health Insurance Program (SCHIP), unless you tell us not to. The information, if disclosed, will only be used to identify eligible children and seek to enroll them in Medicaid or SCHIP. NON-DISCRIMINATION STATEMENT This explains what to do if you believe you have been treated unfairly. In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discrimination on the basis of race, color, national origin, sex, age, or disability. To file a complaint of discrimination, write USDA, Director, Office of Adjudication, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call, toll free (866) 632-9992 (Voice). Individual who are hearing impaired or have speech disabilities may contact USDA through the Federal Relay at (800) 877-8339) or (800) 845-6136 (Spanish). USDA is an equal opportunity provider and employer. Form 581-3514e-P (Rev. 04/13) Page 2 (NSLP)

Permission to share 2013-14 Confidential Meal Eligibility Status to receive additional benefits or services for your child Dear Parent or Guardian: If your student is eligible for free or reduced-price school meals, he or she may also qualify to receive other benefits. To give your permission for us to share your child s name and meal eligibility status with staff in charge of the programs listed below, select either Option One or the specific opportunities in Option Two and sign this form. Select Option Three if you do not want to share your child s eligibility status. Please note that there is NO GUARANTEE of additional benefits. Not all schools have funding to offer local program fee waivers or fee reductions to students. Selecting any of these options will not change whether your student(s) get free or reducedprice school meals and is NOT a requirement for participation in the school nutrition program. Option One: Yes! Share my child(ren) s eligibility status to all programs in my school district. Option Two: Yes, for ONLY the opportunities checked below, share my child s eligibility status with staff in charge. 1. Educational/school related program fee waiver or reduction field trips, educational workbooks, elective class lab fees, college tuition fees, night school fees, summer school fees, fee-for-service Kindergarten or pre-k fees, Outdoor School fees, PSAT/SAT/ACT test fees Listed benefits are NOT 2. Athletic programs fee reduction guaranteed by this form. NOT all schools receive 3. Administrative school programs fee waiver or reduction - funding to provide fee Before & After School Program fees, Bus/Transportation fees, waivers or fee reductions. Student activities fees (dances), Student Body Card fees Transfer to a school of choice (eligibility is "weighting" factor for school transfer lottery) 4. Medical/dental services fee waiver/reduction Option Three: NO! Do NOT share my child s free or reduced-price eligibility for school meals with any programs. If you checked Option Three, you do NOT have to complete this form. Your child s eligibility status for free or reduced-price school meals will not be shared unless a signed consent form is returned. If you checked Option 1 or specific opportunities in Option 2, complete the student information below, sign, date, and return this consent form with your meal application. Your child's confidential eligibility information will be shared only with staff in charge of the opportunities you selected. Student s Name(s): School(s): Student s Name(s): School(s): Student s Name(s): School(s): Signature of Parent/Guardian: Date: Printed Name: Signature and date are required. USDA, the State of Oregon, and Portland Public Schools are equal opportunity providers. Page 3

Portland Public Schools Nutrition Services 2013-14 Confidential Family Application for Free or Reduced-Price Meals Is your family application for school meals complete? Your application for free or reduced-price meal benefits cannot be processed if any of the required information is missing. All applications need a signature Is the application signed by an adult household member and dated? Income Applications Parts 1, 2, 4 & 5 Are the last 4 digits of the Social Security number of the adult household member included on the form? If you do not have a social security number, have you checked the box indicating that you do not have one? Are the names of ALL household members listed? Include infants, pre-school aged children and all adult household members. Have you listed the monthly income for all household members? SNAP or TANF Applications Parts 1, 2, 3 & 5 Have you included a valid Supplemental Nutrition Assistance Program (SNAP) Benefits (formerly the Food Stamp Program) case number (nine digits)? Example: F 1 1-1 1-1 1 1 1 (Do NOT use an Oregon Trail Card # or medical card #) OR Have you included a valid TANF (Temporary Assistance for Needy Families) case number - six characters: A A 1 1 1 1 or A A A 1 1 1? Foster Child Parts 1, 2 & 5 Have you marked the checkbox if they are a formally placed foster child? A foster child is the legal responsibility of SCF (Services to Children and Families) or the court. If you have questions about meal applications, please call 503.916.3402 or email Portland Public Schools Meal Benefits Center at mealbenefits@pps.net. If you received an Eligibility Notification Free Meal Benefits letter, you do NOT need to complete a meal application. Call 503.916.3402 for assistance if some students in your household received the Eligibility Notification Free Meal Benefits letter, but others did not. Page 4.

Hay NUEVOS estudiantes en esta solicitud? sí no SOLICITUD FAMILIAR CONFIDENCIAL 2012-2013 PARA COMIDAS GRATIS Y DE PRECIO REDUCIDO AVISO: Si ha recibido una NOTIFICACIÓN DE ELEGIBILIDAD PARA COMIDAS GRATIS del distrito escolar, no complete esta solicitud. Vea las Instrucciones para completar la solicitud al dorso de este formulario. 1 INFORMACIÓN DEL HOGAR Nombre de la persona que completa esta solicitud (Apellido, Primer nombre) 444444444444444444444444444 Nombre Escriba 444444444444444444444444444 Dirección postal Apt # 444444444444444444444444444 Ciudad Estado Código Postal 2 INFORMACIÓN DE LOS ESTUDIANTES Nombre del niño (Apellido, Primer nombre) Escuela Teléfono particular o móvil (marque uno con un círculo) 44444444444 Teléfono del trabajo 44444444444 Número de integrantes del hogar (Escriba los nombres de todos los integrantes del hogar en las partes 2 y/o 4 de este formulario) 1. 4444444444444 2. 4444444444444 3. 4444444444444 4. 4444444444444 5. 4444444444444 4444444 4444444 4444444 4444444 4444444 4444 4444 4444 4444 4444 44444 44444 44444 44444 44444 3 BENEFICIOS Si algún miembro del hogar recibe SNAP o TANF, dé el nombre y número de caso del miembro que recibe los beneficios. Nombre 44444444444444 SNAP TANF Grado Fecha de nacimiento Número de caso Recibe este hogar FDPIR (Distribución de comida en reservaciones indígenas) Sí 4 MIEMBROS DEL HOGAR E INGRESO MENSUAL BRUTO si no es mensual, vea las conversiones al dorso Columna 1 Liste todos los miembros del hogar, incluidos niños, que no asisten a la escuela, y el ingreso. No incluya a los estudiantes listados en la parte 2, a menos que reciban ingresos regulares. (Apellido, Primer nombre) 1. 4444444444 2. 4444444444 3. 4444444444 4. 4444444444 Columna 2 Ingreso mensual (Ganancias y sueldos totales antes de deducciones) 444444 444444 444444 444444 Columna 3 Manutención infantil, Asistencia social, Pensión alimenticia Recibidas por mes 4444444 4444444 4444444 4444444 Columna 4 Mensual pensiones, Retiro del Seguro Social por mes 444444 444444 444444 444444 Columna 5 Otro Ingreso mensual Incluido Seguro de desempleo Y Compensación laboral 444444 444444 444444 444444 Comprobar si los niños de crianza temporal Siga abajo en la Parte 5 Columna 6 Marque si no hay ingreso 5 FIRMA, FECHA Y últimos cuatro números del NÚMERO DE SEGURO SOCIAL (Un adulto debe firmar) Certifico (prometo) que toda la información en esta solicitud es verdadera (correcta) y que he informado todos los ingresos. Entiendo que la escuela obtendrá fondos federales en base a la información que proporcione. Entiendo que los funcionarios de la escuela pueden verificar (controlar) la información. Entiendo que si doy información deliberadamente falsa, mis hijos pueden perder los beneficios de comidas y se me puede procesar. Firma de un miembro adulto del hogar Firmado en X Mes/día/año 6 GRUPO RACIAL O ÉTNICO (OPCIONAL) Marque una identidad étnica: Marque una o más identidades raciales: Hispano o latino Asiático No hispano ni latino Indio americano y nativo de Alaska Nativo de Hawai o de otra isla del Pacífico Número de Seguro Social * (Ver declaración de privacidad al dorso) XXX-XX- No tengo número de Seguro Social Negro o afroamericano Blanco, no de origen hispano Otra Prefiero recibir toda la correspondencia en Español Ruso Otro 7 No deseo que mi información se comparta con el programa de seguro de salud de niños del Estado Firme aquí:: Tengo un hijo (o hijos) que no tienen ningún tipo de cobertura de salud ni de seguro de salud privado ni de Oregon Health Plan / Healthy Kids. Estoy interesado en libre o reducción del coste de la cobertura de salud para al menos uno de mis hijos. Sí No SCHOOL USE ONLY - DO NOT WRITE BELOW THIS LINE Total Income: Number in household: Date Withdrawn: Free based on: SNAP/TANF/FDPIR Foster child categorical household income Reduced based on: household income Denied Reason: income too high incomplete application Determining Official s Signature : Date Form 581-3514e-P - Spanish (Rev. 05/12) Page 1 VEA INFORMACIÓN IMPORTANTE AL DORSO

Instrucciones para completar la solicitud Si su hogar recibe SNAP, TANF o FDPIR, complete las partes 1, 2 y 5; las partes 6 y 7 son opcionales. Si no recibe estos beneficios y su ingreso se encuentra por debajo de las pautas, complete las partes 1, 2, 4 y 5; las partes 6 y 7 son opcionales. Si en su hogar hay un NIÑO BAJO TUTELA TEMPORARIA, complete las partes 1, 2, 4 y 5; las partes 6 y 7 son opcionales. CÓMO DETERMINAR EL INGRESO MENSUAL PARA GANANCIAS Y SUELDOS En la Parte 4 de esta solicitud debe informarse el ingreso mensual de todos los miembros del hogar. El término ingreso significa cualquier dinero que se recibe regularmente por trabajo, manutención infantil, pensión alimenticia, pensiones, retiros, seguro social o cualquier otra fuente. Excluya préstamos estudiantiles/escolares. Los miembros del hogar que no cobran mensualmente deben convertir los ingresos a ingresos mensuales de la siguiente manera: Miembros del hogar que cobran cada semana: Multiplique por 52 los ingresos y sueldos totales de un periodo de pago, antes de las deducciones. Luego divida por 12. La cifra resultante es el ingreso mensual total. Miembros del hogar que cobran cada 2 semanas: Multiplique por 26 los ingresos y sueldos totales de un periodo de pago, antes de las deducciones. Luego divida por 12. La cifra resultante es el ingreso mensual total. Miembros del hogar que son trabajadores de temporada o que trabajan menos de 12 meses: Proyecte el porcentaje de ingreso anual de ingreso para representar correctamente las circunstancias presentes y luego divida por 12. La cifra resultante es el ingreso mensual proyectado. Nota: El dinero que recibe de un negocio o una granja que es de su propiedad se debe informar como ingreso neto. El ingreso neto se define como el ingreso total que queda después de substraer los gastos para operar el negocio o la granja de los recibos brutos. PAUTAS FEDERALES PARA INGRESO Sus hijos pueden calificar al menos para comidas a precio reducido si el ingreso de su hogar cae dentro de los límites de esta tabla. Comidas a precio reducido Dos veces Cada dos Tamaño del hogar Anual Mensualmente Semanalmente por mes semanas -1-20,665 1,723 862 795 398-2- 27,991 2,333 1,167 1,077 539-3- 35,317 2,944 1,472 1,359 680-4- 42,643 3,554 1,777 1,641 821-5- 49,969 4,165 2,083 1,922 961-6- 57,295 4,775 2,388 2,204 1,102-7- 64,621 5,386 2,693 2,486 1,243-8- 71,947 5,996 2,998 2,768 1,384 Para cada miembro adicional de la familia añadir 7,326 611 306 282 141 DECLARACIÓN DE PRIVACIDAD NÚMEROS DE SEGURO SOCIAL La Ley Nacional de Almuerzo Escolar Richard B. Russell requiere la información en esta solicitud. Usted no tiene que dar la información pero si no lo hace no podemos aprobar a su hijo para que reciba comidas gratis o a precio reducido. Debe incluir los últimos 4 dígitos del número de seguro social del miembro adulto del hogar que firma la solicitud. Los últimos 4 dígitos del número de seguro social no se requieren cuando usted hace la solicitud en nombre de un niño bajo tutela temporaria o lista el Programa de SNAP, un número de caso del Programa de Asistencia Temporaria para Familias Necesitadas (TANF) o un identificador para su hijo del Programa de Distribución de Alimentos en Reservaciones Indígenas (FDPIR), o cuando usted indica que el miembro adulto del hogar que firma la solicitud no tiene un número de seguro social. Usaremos su información para determinar si su hijo es elegible para recibir comidas gratis o a precio reducido, y para administrar y hacer cumplir los programas de almuerzo y desayuno. Podemos compartir su información de elegibilidad con programas de educación, salud y alimentación para ayudarles a evaluar, financiar o determinar beneficios para sus programas; con auditores de revisión de programas y con funcionarios del orden para ayudarles a detectar violaciones a la reglas de los programas. Podemos compartir la información de este formulario con Medicaid o el Programa de Seguro de Salud de Niños del Estado (SCHIP), a menos que usted nos diga que no lo hagamos. La información, si se revela, se utilizará para identificar niños elegibles y tratar de inscribirlos en Medicaid o SCHIP. DECLARACIÓN DE NO DISCRIMINACIÓN Esto explica qué hacer si considera que ha sido tratado injustamente. De acuerdo con la ley Federal y El Departamento de Agricultura de los EE. UU. (USDA por sus siglas en inglés) esta institución prohíbe la discriminación a base de raza, color, origen nacional, sexo, edad, o impedimentos. Para presentar una reclamación de discriminación, escriba a USDA, Director, Office of Adjudication, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 o llame gratis al (866) 632-9992 (voz). Las personas con dificultades auditivas o discapacidades del habla pueden comunicarse con el USDA a través del Sistema Federal de Transmisiones al (800) 877-8339 o al número (866) 845-6136. USDA es un proveedor y empleador que ofrece igual oportunidad a todos. Form 581-3514e-P- Spanish (Rev. 05/12) Page 2

Permiso para compartir el estado confidencial de elegibilidad para comidas escolares para el año 2012-13 para recibir beneficios o servicios adicionales para su hijo/hija. Estimado padre de familia o tutor legal: Si su estudiante es elegible para comidas provistas por la escuela gratuitas o de precio reducido, él o ella puede también calificar para recibir otros beneficios. Para dar su permiso para que nosotros compartamos el nombre y la condición de elegibilidad para comidas escolares de su hijo/hija con el personal encargado de los programas enumerados a continuación, seleccione la Opción uno o las oportunidades específicas en la Opción dos y firme este formulario. Seleccione la Opción tres si usted no quiere compartir el estado de elegibilidad de su hijo/hija. Por favor tenga en cuenta que NO HAY NINGUNA GARANTÍA de beneficios adicionales. No todas las escuelas cuentan con fondos para ofrecer la exención o la reducción de pago para programas locales para los estudiantes. Seleccionar cualquiera de estas opciones no cambiará el hecho de que su estudiante reciba comidas escolares gratuitas o de precio reducido y NO es un requisito para participar en el programa de nutrición de la escuela. Opción uno: Sí! Comparta el estado de elegibilidad de mi(s) hijo(s) con todos los programas en mi distrito escolar. Opción dos: Si, comparta el estado de elegibilidad de mi hijo/hija con el personal encargado SOLAMENTE para las oportunidades seleccionadas a continuación. 1. Exención o reducción de cuota para programas educativos/relacionados con la escuela Viajes de estudio, cuadernos de actividades educativos, costos de laboratorio para clases opcionales, cuotas para la matrícula de universidades, cuotas para la escuela nocturna, cuotas para la escuela de verano, cuota-por-servicio de kindergarten y pre-kinder, cuota para la Escuela al aire libre, cuotas para lo exámenes de PSAT/SAT/ACT 2. Reducción de cuota para programas atléticos 3. Exención o reducción de la cuota administrativa para programas NO todas las escuelas reciben de la escuela Cuota para los programas de antes y después de fondos para proporcionar la exención o la reducción de cuotas. la escuela, cuotas para el autobús escolar/transporte, cuotas para las actividades estudiantiles (bailes), cuota para la tarjeta de identificación estudiantil, transferencia a una escuela de su elección (elegibilidad es un factor de peso para la lotería de transferencia de escuelas) 4. Exención o reducción de cuota para servicios médicos/dentales Los beneficios en esta lista NO están garantizados por este formulario. Opción tres: NO! NO comparta la elegibilidad de mi hijo/hija para las comidas de la escuela gratuitas o de precio reducido con ningún programa. Si usted seleccionó la Opción tres, usted NO tiene que completar este formulario. El estado de elegibilidad de su hijo/hija para las comidas escolares gratuitas o de precio reducido no será compartido a menos que un formulario de consentimiento sea entregado. Si usted seleccionó la Opción 1 o seleccionó oportunidades específicas en la Opción 2, complete la siguiente información del estudiante, fírmelo, escriba la fecha, y regrese este formulario de consentimiento, con su solicitud para comidas. La información confidencial de elegibilidad de su hijo/hija solo será compartida con el personal encargado de las oportunidades que usted seleccionó. Nombre(s) del estudiante: Escuela(s): Nombre(s) del estudiante: Escuela(s): Nombre(s) del estudiante: Escuela(s): Firma del Padre/Tutor legal: Fecha: La firma y la fecha son Nombre impreso: requeridas Esta institución es un proveedor que ofrece iqual oportunidad a todos 3

Servicios de Nutrición de Portland Public Schools Ha Completado su Solicitud de Comidas de La Familia? Su solicitud para beneficios Comidas Gratis o a Precio Reducido no puede ser procesada si falta cualquiera de la información requerida Todas las solicitudes necesitan tener una Firma Está la solicitud firmada por un miembro adulto del hogar y fechada? Solicitudes de Ingresos Secciones 1, 2, 4 y 5 Esta incluido los últimos 4 dígitos del número de seguro social del miembro adulto del hogar que firma la solicitud? Si usted no tiene un número del Seguro Social ha marcado la casilla indicando que no lo tiene? Están TODOS los nombres de los miembros de la casa en la lista? Incluya los infantes, niños de edad pre-escolar y todos los miembros adultos del hogar. Ha anotado usted el ingreso mensual de todos los miembros del hogar? SNAP (Estampillas de Comida) o Solicitudes de TANF Secciones 1, 2, 3 y 5 Ha incluido usted un número de caso válido de *Programa de Asistencia Suplementaria (SNAP) anteriormente Programa de Cupones de Alimento (nueve dígitos) por el nombre de cada estudiante? Ejemplo: F 1 1-1 1-1 1 1 1 (NO use un número de Oregon Trail Card o de tarjeta médica) Ha incluido usted un número de caso válido de TANF (Temporary Assistance For Needy Families) seis letras o números: A A 1 1 1 1 ó A A A 1 1 1 por el nombre de cada estudiante? Solicitudes para el Sistema de Crianza (Foster Child) Seccion 1, 2, y 5 SolicSoliciitudes para el Sistema de Crianza (Foster Child) Sección 1, 2, y 5 Marque la casilla si son niños formalmente colocados bajo tutela temporaria en la familia. Un niño en el sistema de crianza (foster child) es la responsabilidad legal de SCF (Services to Children and Families) o la corte. Si tiene usted preguntas sobre una solicitud de comidas, por favor llame a Portland Public Schools Meal Application Center al 503-916-3402. Si ha recibido una carta de Eligibility Notification Free Meal Benefits, No necesita completar una solicitud para comidas. Si no recibió esta carta de notificación para todos los niños en su casa, llame 503-916-3402. 4

PORTLAND PUBLIC SCHOOLS Student Registration Form Your student s registration form: Important for you and Portland Public Schools Student registration forms are very important for your family and for Portland Public Schools. The information you provide allows us to: ffdistribute important school or school district information to you, including your student s academic progress (report cards) and attendance information. ffrespond appropriately in the event of a medical situation involving your student. ffcontact you or others if there is a school emergency. Information from registration forms also supports students academic success by allowing the school district to: ffhelp your student receive support such as language services. ffseek grants to strengthen classroom instruction. ffevaluate our work on behalf of student groups (racial/ethnic, socioeconomic, etc.). ffensure that we are in compliance with civil rights laws regarding students and staff. Instructions: The registration form is a required official record. The questions on this form ask for important information that will help provide services for your student. If you need help filling out this form, please contact your school. Please print using a black ball point pen, complete all pages and sign and date the last page. If any information should change during the school year, notify your school immediately. Student Name Grade Language Information 1. What is the student s first language? 2. What language is spoken by the student at home? If a language other than English is given to either of the above questions, your student will be referred for English language assessment to determine if he/she qualifies for ESL services. 3. Is the student in, or has the student been in, an English as a Second Language Program? Yes No In a Bilingual/Dual Program? Yes No Your family has the right to receive information in your home language. 4. Does your family need an interpreter for school meetings? Yes No (If yes, please indicate language on page two in #s 42/60) 5. Does your family want to receive translated printed materials at home? Yes No (If yes, please indicate language on page two in #s 43/61) Federal Title Program Questions (Note to school staff: If a family checks Yes for any of these questions, please fax this page to 503 916 3111) Title VII A Program, Indian Education This information establishes the district s eligibility for a federal grant under the Title VII A of the No Child Left Behind Act. You will receive more information if you mark Yes. 6. Is the student, a parent, or a grandparent, a member of a U.S. federally recognized American Indian Tribe? Yes No If Yes, please fill in tribe name Oregon Title I C Migrant Education Program This program helps children and young adults ages 3 21 who move frequently (on their own or with their parents) in order to seek or obtain temporary or seasonal work in agriculture, forestry and/or fishing activities. 7. A person in my family has worked in, or has planned to work in, agriculture, forestry and/or fishing. This can include work on farms, ranches, canneries, nurseries, trees or fishing. Yes No Title X McKinney Vento Program This program guarantees that students, no matter their living situation, have access to public education, including transportation to and from school. A school district representative will be in touch if you check a box. 8. Please place a check in the appropriate box if it applies: You are staying in a motel, car or campsite until you can find affordable housing You are sharing housing with another family due to economic hardship Your child is living with a relative, friend or anyone other than his/her biological parents You are living in a shelter, temporary housing or moving from place to place without permanent housing You are experiencing housing difficulties related to finances and would like to be contacted about services At Home Through School Revision Date: May 21, 2013

Student Name Student ID # School Grade Homeroom Official use only Student Information 9. Legal Last Name 10. Legal First Name 11. Preferred Last Name 12. Preferred First Name 13. Legal Middle 14. Birthdate 15. Gender Female Male 16. Place Of Birth: City State Country 17. Family Primary Phone No. (Note: Family phone number will be used for attendance and emergency notifications) Receive text messages at this number? Yes No Federal and State Regulations require PPS to gather information in 18a. and 18b. for statistical reports. If you need more information, your school can help. 18a. Ethnicity Hispanic/Latino? Yes No (Note: both Ethnicity and Race must be selected) 18b. Race select at least one American Indian or Alaska Native Asian Black Native Hawaiian or Other Pacific Islander White 19. Home Address Apt. # 20. City 21. State 22. Zip 23. Mailing Address (If Different From Home) 24. City 25. State 26. Zip 27. Student Cell Phone No. 28. Student Email Address Family Information Contact phone numbers, address and email addresses will be used to distribute important school and district information. Online access to student records will be provided to each parent/responsible Adult listed below. 29. Parent/Responsible Adult: Mother Father Guardian Other 30. Legal Last Name 31. Legal First Name 32. Living with Student: Yes No 33. Same as Student Address Yes No (If no, please provide full address on #34; check if you want copy of correspondence ) 34. Address (if different than #19) Apt. # 35. City 36. State 37. Zip 38. Primary Phone No. (if different than #17) 39. Secondary Phone No. 40. Work Phone No. 41. Email Address 42. Interpreter is needed in the following language 43. In which translated language do you want printed materials? Chinese English Russian Somali Spanish Vietnamese 44. Interested in volunteering: Yes No 45. Live/work on federal property: Yes No 46. Permission to pick up: Yes No 47. Parent/Responsible Adult Mother Father Guardian Other 48. Legal Last Name 49. Legal First Name 50. Living with student: Yes No 51. Same as student address: Yes No (If no, please provide full address on #52; check if you want copy of correspondence ) 52. Address (if different than #19) Apt. # 53. City 54. State 55. Zip 56. Primary Phone No. (if different than #17) 57. Secondary Phone No. 58. Work Phone No. 59. Email Address 60. Interpreter is needed in the following language 61. In which translated language do you want printed materials? Chinese English Russian Somali Spanish Vietnamese 62. Interested in volunteering: Yes No 63. Live/work on federal property: Yes No 64. Permission to pick up: Yes No Revision Date: May 21, 2013

Student Name Student ID # School Grade Homeroom Official use only Additional Emergency Contacts In an emergency, the parent/guardian listed in #30 will be called first, the parent/guardian listed in #48 will be called second. By listing a name or names in this section as an emergency contact, you are authorizing another person or people to pick up your student at school if you cannot be reached. 65. Last Name 66. First Name 67. Relationship To Student 68. Primary Phone No. 69. Additional Phone No. 70. Additional Phone No. 71. Last Name 72. First Name 73. Relationship To Student 74. Primary Phone No. 75. Additional Phone No. 76. Additional Phone No. 77. Last Name 78. First Name 79. Relationship To Student 80. Primary Phone No. 81. Additional Phone No. 82. Additional Phone No. 83. Last Name 84. First Name 85. Relationship To Student 86. Primary Phone No. 87. Additional Phone No. 88. Additional Phone No. Student Medical Information School staff need to know if your student has a medical condition for which he/she may require assistance during the school day. Remember to advise the school of any changes in information. 89. Doctor s Name (optional) 90. Phone No. (optional) 91. Dentist s Name (optional) 92. Phone No. (optional) 93. Preferred Hospital County-operated Emergency Medical Services (EMS) makes the final decision for site of best available care when serious illness, accident or other emergency event directs need for transporting to a hospital. If possible, the school will advise EMS of your hospital preference. 94. Insurance Carrier (optional) Health Care Reform creates access to medical insurance for everyone at no cost or tax credits to help pay for health care coverage. If you would like help accessing health coverage, please check the box so we can contact you. 95. Please check any current medical conditions: Serious Allergies Life Threatening? Yes No Asthma Heart Disease Seizure Disorder Diabetes Type I Type II 96. Other special health needs at school 97. Medications to be taken at school (please list and also complete the Authorization for Medication form) Siblings Please list student s sibling(s) currently attending a Portland Public Schools school. 98. Sibling Last Name 99. Sibling First Name 100. Relationship To Student 101. School 102. Grade 103. Sibling Last Name 104. Sibling First Name 105. Relationship To Student 106. School 107. Grade 108. Sibling Last Name 109. Sibling First Name 110. Relationship To Student 111. School 112. Grade Revision Date: May 21, 2013

Student Name Student ID # School Grade Homeroom Official use only Program Information 113. Does your student have a current Individualized Education Plan (IEP)? Yes No 114. Does your student have a current Section 504 Plan? Yes No 115. Is your student in a Talented and Gifted (TAG) program? Yes No Previous School Information 116. When did the student first begin school in the US? 117. Previous School(s) Attended In Last Three Years 118. Previous School(s) Address(es) (City, State and Country, if outside PPS) 119. Previous School(s) Phone No. (if outside of PPS) 120. Dates Attended Permissions/Authorizations For annual notices on Directory Information, Student Records, Military Recruiting and Protection of Student Rights, please see the District Parent and Student Handbook. Under federal law and school policy, the school district may release the following information without prior parental consent: Student name, participation in officially recognized activities and sports, weight and height of members of athletic teams, degrees, honors, and awards received, major field of study, dates of attendance and the most recent school attended. If you do not want this information released, please contact your school to submit a written request. This form must be completed each year [Non Release of Student Directory Information Form]. *Student photographs are commonly used in yearbooks, newsletters, websites and other school related publications. If you do not want your student s photograph used or released for these purposes or for news media, please contact your school to submit a written request [Publicity Denial and Non Release of information to School Directory Form]. *Many schools or PTAs publish school directories that include parent/guardian contact information. If you do not want your name and contact information released for the school directory, please contact your school to submit a written request [Publicity Denial and Non Release of information to School Directory Form]. *If you do not want your student to have access to district-provided email and on-line educational tools, please contact your school. High School Only 121. I do not want my child s name, address and phone number released to: Military Recruiters College Recruiters The No Child Left Behind Act of 2001 requires school districts to provide, upon request, the names, addresses and phone numbers of high school juniors and seniors to military recruiters, colleges and universities. If you do not want the school district to provide information about your student to either the military or colleges and universities, you have the opportunity to opt out. In order to do so, you must check one or both of the categories above. By signing this form, I agree that all the information is true. If it is determined that the address I have provided is false, I acknowledge that my student could be removed from the school immediately. 122. Signature of Parent/Responsible Adult (Required) Date 123. Signature of Parent/Responsible Adult Date Portland Public Schools wishes you and your student a successful academic school year! Revision Date: May 21, 2013

APPENDIX F Portland Public Schools Synergy Information

Synergy Reference Guide E1 Enroll a Student This guide outlines the steps to enroll an existing or new student into Synergy. To review specific enrollment processes, refer to the PPS Enrollment Handbook. Enroll a Student Step 1 Go to: Synergy SIS > Student > Student On the Student screen, click Add to open the Student Find screen (Step 2). Step 2 Step 3 a. Enter search criteria it can be a combination of fields (i.e. Last Name, First Name, or Student ID). b. Click Find, or Enter on your keyboard. A list of students that meet the search criteria will display. LEGEND White: The student is currently enrolled at a school. Look at the School column for the name of the school. If it is your school name, you do not need to re enroll the student. Blue: The student is not enrolled at a school in the current school year. Look at the School Year column to find out which focus year the student was actively enrolled. Yellow: The student is currently not enrolled at a school and can be enrolled at any time. a. If the student you are looking for is in the list and the row is white, look at the School column and contact the school secretary to inactivate the student so you can enroll. When the student has been inactivated, repeat Steps 1 2 and go to Step 3b. b. If the student you are looking for is in the list and the Status is I (Inactive), double click on the Line number, or click once and click Transfer. Go to Step 4. c. If the student you are looking for is highlighted blue, double click on the Line number, or click once and click Transfer. Proceed to Step 4. d. If the student you are looking for is NOT listed, go to Step 5. July 2013 Page 1 of 4 Published by: PPS IT Training

SYNERGY REFERENCE GUIDE ENROLL A STUDENT PORTLAND PUBLIC SCHOOLS Step 4 Step 5 Step 6 At minimum, input the required fields highlighted green (click on the Enrollment tab and select: Grade, Enter Date, Enter Code,* etc.), and make any demographic edits as per the Student Registration Form. Click Save. *See Page 3 for a list of Enter Codes. To add a new student, click Add New. Student > Demographics tab Input the required fileds highlighted in green. Do NOT click Save until after completing Step 7. NOTE: Required fields not highlighted are: Ethnic Code, Home Address City, State, & Zip Code. Rule of Thumb: Input all of the information listed in the Student Registration Form. Phone Numbers: To input phone numbers, click Add and indicate which is Primary, the Type, Phone, Extension, and Contact preference, if applicable. Click Save when done inputting the phone number. Step 7 Click on the Enrollment tab. Input the Enter Date, Enter Code, and any other required/highlighted fields not already populated. Click Save to return to the main Student screen. Input the rest of the demographic information (e.g., home language related fields) and continue to each tab until all information listed on the student registration form is inputted. Click Save. July 2013 Page 2 of 4 Published by: PPS IT Training

SYNERGY REFERENCE GUIDE ENROLL A STUDENT PORTLAND PUBLIC SCHOOLS NOTE FOR HIGH SCHOOLS: Step 8 When enrolling new high school student, it is important to enter the NinthGrade Entry Year as it determines to the Graduation Requirement Class of Year. If this is applicable to the student you are enrolling, go to Step 8. Click the Other Info tab > Graduation Information > Ninth Grade Entry Year Select a year from drop down menu. Click Save. NOTE: The instructions below assume the student has been identified and is on the Student screen. Modify a Student s Enter Date Step 1 Go to: Student > Enrollment History Click on the Enter Date link. Step 2 Type in the new Enter Date (MM/DD/YYYY), or click on the calendar icon to select a date. Click Save. Modify a Student s Enter Code Step 1 Go to: Student > Enrollment History Click on the Enter Code link. Step 2 Select the correct Enter Code from the drop down menu. Click Save. July 2013 Page 3 of 4 Published by: PPS IT Training

Synergy Enter Code Grades When to Use ADA/ADM Status Instructional Hours Type Standard Enrollment All Student is attending a PPS school Reports to the State NS: Concurrent Enrollment All NS: Credit Recovery 9 12 NS: Early Graduate* 11, 12 NS: Extended Leave* NS: Extra Curricular Activities* NS: Homebound, Receiving Tutoring All All All Non Standard: Student is attending a PPS school, and is also attending another program or school where a course is not offered concurrently (e.g., Portland Evening Scholars, DESCC) Non Standard: Student is attending a credit recovery program (e.g. Portland Evening Scholars, Portland Virtual Scholars) student needs to keep in contact with the neighborhood school For early graduates who have been inactivated, but need to be re enrolled for graduation related communications only Non Standard: Student has left for an extended period of time (exceeding 10+ days) for various reasons (e.g. long term medical, vacation, studying abroad), but plans to return. The home school enrolls the student to retain the student s schedule upon return. Non Standard: Student receives instruction elsewhere, but is attending for extra curricular activities (e.g. Jefferson Dance program, athletics, band, choir, etc.) Non Standard: Student is home bound or in a facility (i.e. hospital), and is receiving tutoring from a licensed instructor Exclude From State Reporting Exclude From State Reporting Exclude From State Reporting Exclude From State Reporting Instructional Hours Only NS: Night School All Non Standard: Student is attending a PPS night school Concurrent NS: Private/Home Schooled, Attending Part Time NS: Receiving SpEd Services Only All All Non Standard: Student is receiving instruction via private or home school, and is taking one or two classes at the neighborhood school Non Standard: Student is receiving instruction elsewhere, and is receiving SPED services at the neighborhood school NS: Testing Purposes Only All Non Standard: Student needs an SSID for state testing Instructional Hours Only Instructional Hours Only Instructional Hours Only Tutorial Shared Time Shared Time only *If this Enter Code is used, go to: Student > Enrollment History tab click on the Enter Date or Enter Code link to open the Enrollment History window. Select Exclude From State Reporting from the drop down menu for the ADA/ADM field. FOR ASSISTANCE CONTACT THE IT SERVICE DESK, 503.916.3375 or itservicedesk@pps.net July 2013 Page 5 of 5 Published by: PPS IT Training

Synergy Reference Guide E2 Concurrent Enrollment This guide explains how to add and remove a concurrent enrollment a process that allows another school or program to view student information when they are not the home school. Create a Concurrent Enrollment Step 1 Go to: Synergy SIS > Student > Student On the Student screen, click Add to open the Student Find screen (Step 2). Step 2 Step 3 a. Enter search criteria it can be a combination of fields (i.e. Last Name, First Name, or Student ID). b. Click Find, or press Enter on your keyboard. A list of students that meet the search criteria will display. Click Next >> to view additional students. LEGEND White: The student is currently enrolled at a school. Look at the School column for the name of the school. Blue: The student is not enrolled at a school in the current school year. Look at the School Year column to find out which focus year the student was actively enrolled. Yellow: The student is in Inactive (I) status and not enrolled at a school. Step 4 a. To select a student, double click on the Line number, or click once on the Line number, and click Transfer. A separate screen will open. Click and maximize the screen. This student is currently enrolled at <school name>. If you continue, this student will be concurrently enrolled message appears under the student s name. Fill in the blank required fields highlighted in green. Or, update any information needed. NOTE: Both the home school and the concurrent school can make changes to student information. July 2013 Page 1 of 4 Published by: PPS IT Training

SYNERGY REFERENCE GUIDE CONCURRENT ENROLLMENT PORTLAND PUBLIC SCHOOLS Step 5 Click on the Enrollment tab and under Enrollment Information group select: Grade, Enter Date (date student began at concurrent school), and the NS: Concurrent Enrollment as the Enter Code. Click Save. Step 6 There are two ways to identify concurrent enrolled students: 1. Enrollment tab > Enrollment Information > ADA/ADM Status. 2. Enrollment History tab and view the ADA/ADM Status column. FOR ASSISTANCE CONTACT THE IT SERVICE DESK, 503.916.3375 or itservicedesk@pps.net July 2013 Page 2 of 4 Published by: PPS IT Training

SYNERGY REFERENCE GUIDE CONCURRENT ENROLLMENT PORTLAND PUBLIC SCHOOLS Step 1 Step 2 How to Delete a Concurrent Enrollment From the main Student screen, enter search criteria it can be a combination of fields (i.e. Last Name, First Name, or Student ID). Click Find, or press Enter on your keyboard. Click on Menu > Inactivate Student. Step 3 a. Enter Leave Date (last day the student attended). b. Select the appropriate Leave Code (see Page 4 for a list of Leave Codes). c. Click Inactivate. NOTE: If the concurrent school queries for the student (focus must be set to show active and inactive students) the student will show up as inactive with the name in parenthesis, and the Leave Date will be populated in enrollment history. Quick Tip: To view a quick list of all concurrent students: 1. Go to Student > Enrollment tab. 2. Click the magnifying glass icon to switch into the Find mode. 3. ADA/ADM Status: Select Concurrent 4. Click Find to open a new window with the results. 5. To export the data into Excel, change the Output Type from PDF to Excel and click Print. o Choose to Open or Save the file. FOR ASSISTANCE CONTACT THE IT SERVICE DESK, 503.916.3375 or itservicedesk@pps.net July 2013 Page 3 of 4 Published by: PPS IT Training

Synergy Leave Codes Synergy Leave Code Ages When to Use 10+ Days Absence All Student has not attended school for 10 consecutive days Deceased or permanently incapacitated All Student has died or is permanently incapacitated Expelled All Student withdraws or transfers due to disciplinary reasons Graduated with standard or modified diploma 15 21 Student graduates with a regular, modified, or adult diploma Left the country All Student moved out of the United States Long term medical leave All Student withdraws due to long term medical reasons No Show: Did not attend this school year All Student never physically attended this school year Personal or academic reasons ** 7 th Gr+ Student withdraws for personal or academic reasons ** Select a Withdraw Factor Code via Student > Enrollment History > Enter Date > ADA/ADM field Received GED 15 21 Student withdraws after receiving GED Received Individual Ed or Participation Certificate Unknown status Went to another PPS school* Went to other school district within OR* Went to private or home school* Went to school out of state* 15 21 Will be over 21 on July 1 21+ Student is over 21 years old All All All All Student withdraws after receiving an alternative credential other than a modified or adult diploma, honorary or foreign exchange certificate, or GED Student withdraws for unknown reasons Student transfers between schools in same district *Enter school name into the Moved To field via Student > Enrollment tab > Enrollment Activity Student moves out of district *Enter school name into the Moved To field via Student > Enrollment tab > Enrollment Activity Student withdraws to attend a non public school or to be home schooled *Enter school name, or "Home" into the Moved To field via Student > Enrollment tab > Enrollment Activity Student moves out of state *Enter school name into the Moved To field via Student > Enrollment tab > Enrollment Activity: if school name is not known, enter state and city name FOR ASSISTANCE CONTACT THE IT SERVICE DESK, 503.916.3375 or itservicedesk@pps.net July 2013 Page 4 of 4 Published by: PPS IT Training