Española Public Schools New Student Registration 2017-2018

Española Public Schools New Student Registration 2017-2018

Legal Student Name (As it appears on birth certificate)
First Name Middle InitialLast Name / Date of Birth: / Grade: / Age:

Welcome to the Española Public Schools where our mission is to provide andcontinuously improve a quality education for all students in a safeenvironment by implementinganeducational program that insuresstudents are prepared tomeet educational and life-long challenges.

Attached are the required forms and list of required documentation. Please complete all forms and return to your child’s school. We look forward to registering and educating your child.

Required Forms / Required Documentation
Registration Checklist
Birth Certificate Verification & Entrance Interview (to be completed by school registrar at time of registration) / Home Language Survey (Bilingual Program) / Birth certificate (Required for verification only, we will not copy this document).
Student Synergy Profile / Bilingual Program Notification / Up-to-date immunization record
Release Form / Medical Authorization, Consent & History Form / Two (2) proof of physical address in the school zone
Code of Conduct / Bus Transportation Information Form and Bus Contract / Most recent Report Card/Grades (if available)
Student Computer Use and Internet Access Form / School Meal Application
(EVHS STUDENTS ONLY) / Transcript (if available) or complete Records Request Form.
(to be filled out August 2017)

Special Education / 504 / SAT Disclosure

My Child Currently has an IEP Qualifying Condition:

My Child Currently has a 504 Plan Qualifying Condition:

My Child Currently has a SAT Plan Area(s) of Concern:

I believe that my child may have a disability or qualifying condition that qualifies my child for IEP, 504, or SAT accommodations, and I request a review of his/her case.

Suspected Disability:
Area(s) of Concern:

Special Programing Considerations

My child is a migrant student. A migratory child is a child who is, or whose parent, spouse, or guardian is, a migratory agricultural worker or migratory fisher, and who, in the preceding 36 months, has moved from one school district to another, to obtain or accompany such parent, spouse, or guardian, in order to obtain temporary or seasonal employment in agricultural or fishing work as a principal means of livelihood.Please consider my child for Migrant Education Program Services (Title I, Part C).

My child is homeless. The McKinney-Vento Act defines homeless children as "individuals who lack a fixed, regular, and adequate nighttime residence." This may include: Children and youth sharing housing due to loss of housing, economic hardship or a similar reason; Children and youth living in motels, hotels, trailer parks, or camp grounds due to lack of alternative accommodations; Children and youth living in emergency or transitional shelters; Children and youth abandoned in hospitals; Children and youth awaiting foster care placement; Children and youth whose primary nighttime residence is not ordinarily used as a regular sleeping accommodation (e.g. park benches, etc); Children and youth living in cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations; and Migratory children and youth living in any of the above situations. Please consider my child for assistance and services offered via the McKinney-Vento Homeless Education Assistance Act.

Parent/Guardian Signature Date:

TRANSCRIPT/RECORDS REQUEST

The following student has enrolled at with the Espanola Public Schools.

(Insert school name)

Legal Student Name (As it appears on birth certificate)
First Name Middle InitialLast Name / Date of Birth: / Grade: / Age:
Last School Attended / Address: / Phone:
Fax: / Dates Attended:
Grade(s) Attended:

Please send the following records:

OFFICIAL TRANSCRIPTS
WITHDRAWN GRADES (CREDITS EARNED TO DATE)
IMMUNIZATION RECORDS/HEALTH RECORDS
SPECIAL EDUCATION RECORDS (if applicable)
TEST RECORDS
ATTENDANCE RECORDS

Please send information to:

(Insert School Name)

Espanola Public Schools

Attention: School Registrar/Counselor

Address:

Fax:

NOTE: FEDERAL LAW (20 U.S.C 1232) CONSENT IS NOT REQUIRED IN ORDER FOR YOU TO TRANSFER EDUCATION RECORDS. CR.F 99.31a – SUCH RECORDS ARE SUBJECT TO DISCLOSURE TO OFFICIALS OF ANOTHER SCHOOL OR SCHOOL SYSTEM IN WHICH THE STUDENTS SEEK OR INTENDS TO ENROLL WITHOUT WRITTEN CONSENT OF THE PARENTS.

***To Be Filed with school counselor or registrar***

STUDENTSYNERGY PROFILE

General Information

Legal First Name / Legal Middle Name / Legal Last Name
State ID / Perm ID / Gender
Male Female / Grade
Birth Date / Birth Place / Birth Country / Enrollment Date
Primary Phone Number(s) / Home Language / Ethnicity /étnico:
Asian Other:
African American
Caucasian (check if Hispanic / Latino)
Native American /AlaskanNative, Tribe:
Home Address / Mailing Address

Transportation

My child live IN SCHOOL ZONE (Must provide eligible bus number address) / My child lives OUT of SCHOOL ZONE(I will provide personal transportation daily)
Bus Route (Morning) / Morning Address / Bus Route (Afternoon) / Afternoon Address

Parent/Guardian Custodial Information

Relation:
Father / Name/nombre: / Address / Employer
Check all
that apply: / Contact Allowed / Education Rights / Has Custody / Mailing Allowed / Enrolling Parent / Release To / Financially Responsible / Deceased
Cell Phone: ( Primary Not Listed Contact Phone)
() / Home Phone: ( Primary Not Listed Contact Phone)
() / Work Phone: ( Primary Not Listed Contact Phone)
()
Relation:
Mother / Name/nombre: / Address / Employer
Check all
that apply: / Contact Allowed / Education Rights / Has Custody / Mailing Allowed / Enrolling Parent / Release To / Financially Responsible / Deceased
Cell Phone: ( Primary Not Listed Contact Phone)
() / Home Phone: ( Primary Not Listed Contact Phone)
() / Work Phone: ( Primary Not Listed Contact Phone)
()

In Case of Emergency: Names of persons who can assume temporary responsibility and are authorized to pick up.

Name / Relationship / Home Phone / Work Phone / Other Phone
Name / Relationship / Home Phone / Work Phone / Other Phone
Name / Relationship / Home Phone / Work Phone / Other Phone
Name / Relationship / Home Phone / Work Phone / Other Phone
Name / Relationship / Home Phone / Work Phone / Other Phone
Name / Relationship / Home Phone / Work Phone / Other Phone
Name / Relationship / Home Phone / Work Phone / Other Phone

Siblings: List all siblings attending school in the Espanola School District.

Name / Gender / Grade / School
Name / Gender / Grade / School
Name / Gender / Grade / School
Name / Gender / Grade / School

RELEASEFORM

Legal Student Name (As it appears on birth certificate)
First Name Middle InitialLast Name / Date of Birth: / Grade: / Age:

In order to comply with FERPA (Family Educational Rights and Privacy Act) and the No Child Left Behind Act of 2001, it will be necessary to obtain parental permission in order to publish or release your child’s name and/or address.

Media / PhotoRelease (Check One)

YES/ NO Igivemypermissionformychildtobeinterviewed by media representatives.

YES/ NO I give my permission for my child to be photographed,orvideotapedbymediarepresentatives.

Student Art Work Permission Slip

YES/ NO Igivemypermissionformychild’sartwork to be displayed and/orpublished inEPSpublications.

School Web Sites

YES/ NO Igivemypermission to allowmychild’sphoto to be published on theEPSDistrictwebsites.

Directory Information (Check One) HIGH SCHOOL ONLY

YES/ NO Iwantmychild’sdirectory/contact information to be disclosed.

Military Recruiter 11th and 12th Grade ONLY

YES/ NO Igivemypermissionformychildto be contacted byamilitaryrecruiter.

Signature of Parent/Guardian ______Date

STUDENT COMPUTER USE AND INTERNET ACCESS RELEASE FORM

Legal Student Name (As it appears on birth certificate)
First Name Middle InitialLast Name / Date of Birth: / Grade: / Age:

AsaconditiontouseoftheSchoolDistrict’scomputersystem,includingaccesstoanduseof the Internet,Iunderstandandagreetothefollowing:

1.ToabidebytheSchoolBoard’s PolicyonAcceptableUseandits ComputerandInternet CodeofConduct.

2.SchoolSiteanddistrict leveladministratorshavetherighttoreviewanymaterials

createdorstoredinanyfiles Imaycreateandtoeditorremoveanymaterialwhichthey, intheirsolediscretion,believemaybeunlawful,obscene,abusive,orotherwise objectionableandIherebywaiveanyrightofprivacywhichImayotherwisehaveto suchmaterial.

3.ThattheEspanolaPublicSchoolDistrictwillnotbeliableforanydirectorindirect, incidentalorconsequentialdamageduetoinformationgainedand/orobtainedviauseof theSchoolDistrict’scomputersystemincluding,withoutlimitation,accesstopublic networks.

4.ThattheEspanolaPublicSchoolDistrictdoesnotwarrantthatthefunctionsofthe SchoolDistrictcomputersystemoranyofthenetworksaccessiblethroughthesystem willmeetanyspecificrequirementsyoumayhave,orthattheSchoolDistrictcomputer systemwillbeerror-freeoruninterrupted.

5.ThattheEspanolaPublicSchoolDistrictshallnotbeliableforanydirectorindirect,

incidental,orconsequentialdamages(includinglostdataorinformation)sustainedor incurredinconnectionwiththeuse,operation,orinabilitytousetheSchoolDistrict computersystem.

6.ThattheuseoftheSchoolDistrictcomputersystem,includingusetoaccesspublic

computernetworks,isaprivilegewhichmaybe revokedbySchoolDistrict administratorsatanytimeforviolationofthedistrict'sAcceptableUseProceduresand CodeofConduct.SchoolDistrict administratorswillbethesolearbiter(s)ofwhat constitutes aviolationofthepolicyorCodeofConduct.

7.InconsiderationfortheprivilegeofusingtheSchoolDistrictcomputersystemandin considerationforhavingaccesstothepublicnetworks,IherebyreleaseEspanolaPublic SchoolDistrict,theSchoolBoard,itsmembers,administrators andemployees,including itscomputeroperators,andanyinstitutionswithwhichtheyareaffiliatedfromanyand allclaimsanddamages ofanynaturearisingfrommyuse, orinabilitytouse,theSchool Districtcomputersystem.

Iherebycertifythat we have reviewed the policy and my child willabidebytheconditionsset forthinthisdocument,theSchool District'sAcceptableUseProcedures andComputerandInternetCodeofConduct.

Parent’s SignatureDateStudent’s SignatureDate

CODE OF CONDUCT - PROHIBITED BEHAVIOR INFRACTIONS

Legal Student Name (As it appears on birth certificate)
First Name Middle InitialLast Name / Date of Birth: / Grade: / Age:

DIRECTIONS: Parents please review with your child and sign and return immediately. Thank you.

Level 1
Behavior Infractions / Level 2
Behavior Infractions / Level 3
Behavior Infractions / Level 4
Behavior Infractions / Level 5
Behavior Infractions
Inappropriate display of affection
Regulated use of electronic devices (cell phone prohibited at elementary level)
Students’ dress and personal appearance
Inappropriate language, displays, or images
Dishonesty / Refusal to cooperate with school personnel
Tobacco use
Disruptive conduct
Criminal damage to property and vandalism (under $250)
Trespassing / Sexual Harassment
Knowledge of alcohol, drugs, or weapons*
Instigation (of disruptive misconduct)
Disorderly Conduct
False Fire Alerts
Academic Dishonesty
Gang Related Activity* / Larceny/Theft over $100*
Criminal damage to property and vandalism over $250*
Sexual battery (includes attempts)*
Alcohol violation*
Fighting (mutual)
Assault, battery, and bullying*
Possession or use of fake weapon*
Other delinquent acts (per NM statutes as determined by law enforcement)* / Extortion/Coercion*
Robbery*
Battery*
Possession of weapon*
Arson*
Drug Violation*

Behaviors marked with an * indicate behaviors for which referral to law enforcement is either (1) required by law; (2) based on the totality of the circumstances, severe enough to merit referral to law enforcement upon the first occurrence; or (3) merit referral to law enforcement if the behavior is repeated. Referral to law enforcement may result in a secondary referral by law enforcement to Juvenile Probation, the District Attorney, or Children’s Court.

Behavior Interventions & Consequences

Level 1
Interventions/Consequences / Level 2
Interventions/Consequences / Level 3
Interventions/Consequences / Level 4
Interventions/Consequences / Level 5
Interventions/Consequences
Student Warning
Student conference
Parental contact
Parental Conference
Student Accountability/ Behavior Contract

Referral to LEVEL 2 / Referral to school support services (Counselor / SAT)
Exclusion from extra-curricular activity (must be within 2 weeks of infraction)
Restitution for damages
Detention
In School Suspension (ISS)
Referral to LEVEL 3 / Referral to a community-based agency
Temporary Suspension (1-3 days, invokes due process)

Referral to Level 4 / Referral to law enforcement
Mid-term out of school suspension (5-10 days, invokes due process)

Referral to Level 5 / Referral to Law Enforcement
Long-term out of school suspension (specified time, exceeding 10 days, invokes time specific due process)
Expulsion (permanent or indefinite time exceeding 10 days, invokes time specific due process)

We have reviewed the behavior infractions and consequences.

Parent’s SignatureDateStudent’s SignatureDate

NEW MEXICO PUBLIC EDUCATION DEPARTMENT LANGUAGE USAGE SURVEY
~for parent or guardian to complete~
The purpose of this survey is to ensure that your child receives the highest quality education and services to which he or she is entitled. The information you provide will be used only to assist the school in making program decisions. You will complete this form only once in your child’s educationalcareer.
Student’s Name: / Date of Birth: / Grade Level:
Answer each question by marking either the YES or NO box. / YES / NO
1. Does the student use a language(s) other than English with his/her family and friends?
2. Do you use a language(s) other than English with the student?
3. Does the student understand when someone communicates with him/her in a language other than English?
4. Does the student read in a language(s) other than English?
5. Does the student write in a language(s) other than English?
6. Does the student interpret for you or anyone else in a language(s) other than English?
7. If you answered YES on one or more of questions 1-6, what language(s) other than English does the student use most frequently at home? Choose up to three.
American Sign Language(ASL)
Arabic
Cantonese
Diné
French
Greek
Hmong
JicarillaApache
Italian / Keres
Khmer
Korean
MescaleroApache
Mandarin
Portuguese
Russian
Somali
Spanish / Tiwa
Tewa
Towa
Vietnamese
Zuni
Other
OTHER QUESTIONS
8.Is the student transferring from another state, district, or school? YES/ NO
9.If yes, please provide location and name of school:
10.Has the student received schooling/education in a language(s) other than English?
YES/ NOIf YES, which language(s)?
10. In what language do you prefer to receive communication from the school?
11.In what language would you prefer to communicate with school staff?
12.Is there anything else we should know about how to best serve your child?
Signature of Parent or Guardian: / Date:
Translator: / Language: / Date:

***To Be Filed in Student Bilingual Cum File***

ENCUESTA DEL USO DEL IDIOMA
DEPARTAMENTO DE EDUCACIÓN PÚBLICA DE NUEVO MÉXICO
~ padres o tutores deben llenar~
El propósito de esta encuesta es asegurar que su hijo/hija reciba una educación de la más alta calidad y los servicios que tiene el derecho de recibir. La información que usted proporcione será utilizada solamente para ayudar a la escuela a tomar decisiones programáticas. Responderá a este formulario solamente una vez en la trayectoria de educación de su hijo/hija.
Nombre del estudiante: / Fecha de nacimiento: / Grado:
Responda a cada pregunta marcando la casilla bajo SÍ o NO / SÍ / NO
1. ¿Usa el/a estudiante otro idioma(s) además del inglés con su familia o sus amigos?
2. ¿Usa usted otro idioma(s) además del inglés con el estudiante?
3. ¿Comprende el estudiante cuando alguien se comunica con él o ella en un idioma además del inglés?
4. ¿Lee el/a estudiante en otro idioma(s) además del inglés?
5. ¿Escribe el estudiante en otro idioma(s) además del inglés?
6. ¿Le interpreta o traduce el estudiante a usted o a alguna otra persona en otro idioma(s) además del inglés?
7. ¿Si respondió SÍ a una o más de las preguntas 1-6, ¿cuále(s) idiomas además del inglés usa el estudiante con más frecuencia en casa? Escoja hasta tres:
American Sign Language(ASL)
Arabic
Cantonese
Diné
French
Greek
Hmong
JicarillaApache
Italian / Keres
Khmer
Korean
MescaleroApache
Mandarin
Portuguese
Russian
Somali
Spanish / Tiwa
Tewa
Towa
Vietnamese
Zuni
Otro
OTRAS PREGUNTAS
8. ¿Se traslada el estudiante de otro estado, distrito o escuela? Si / NO
Si este es su caso, favor de proveer la ubicación y el nombre de la escuela:
9. ¿Ha recibido el estudiante instrucción escolar en otro(s) idioma(s) además del inglés? Si / NO
¿Si la respuesta es sí, cuál idioma(s)?
10. ¿En cuál idioma prefiere recibir información de la escuela?
11. ¿En cuál idioma prefiere comunicarse con los empleados de la escuela?
12. ¿Hay algo más que deberíamos saber para servir mejor a su hija/hijo?
Firma del padre o tutor: / Fetch:
Traductor/intérprete: / Traductor/intérprete: / Traductor/intérprete:

***To Be Filed in Student Bilingual Cum File***

BilingualEducationProgramParentNotification

(Versión española al reverso)

Legal Student Name (As it appears on birth certificate)
First Name Middle InitialLast Name / Date of Birth: / Grade: / Age:

Dear Parent:

This letter is to inform you that insert school name offers a Bilingual Multicultural Education Program (BMEP). The program’s goals are for all students to become bilingual and biliterate in English and a second language and to meet state academic content standards and benchmarks in all subject areas.

The cognitive and affective development of students in the program is encouraged by using the cultural and linguistic backgrounds of the students, providing students with opportunities to expand their conceptual and linguistic abilities and potentials in a successful and positive manner, and teaching students to appreciate the value and beauty of different languages and cultures. Your son/daughter insert student’s name has been placed in the school’s BMEP. The following BMEP model(s) is used in theprogram:

Heritage—is designed to support and revitalize a student's native language and culture through oral and/or written language instruction as prescribed by NMAC 6.32.2.12 (D)(3). English learners served in this model receive one hour of language arts in the Spanish or Tewa (target) language, and one hour of English as a second language/English language development. Fluent English Proficient students in this model receive one hour of language arts in the Spanish or Tewa home/heritage (target) language.

Parents with children participating in the school’s BMEP are encouraged to participate in the BMEP parent advisory committee (PAC). Please consider attending our one of our meetings. Parent participation in the development, implementation, and evaluation of the program is valued and important, as we consider what BMEP works best for your children and the community.

We highly recommend that your child participate in, and receive the benefits from, this program. However, you have the right to decline your child’s participation in/opt your child out of the BMEP. If you have questions, you are encouraged to call or visit ouroffice.

Sincerely,

Myra L. Martinez

Associate Superintendent

Bilingual Multicultural Education Director

Signature of Parent/Guardian ______Date

***To Be Filed in Student Bilingual Cum File***

Notificación de programa educación bilingüe

Legal Student Name (As it appears on birth certificate)
First Name Middle InitialLast Name / Date of Birth: / Grade: / Age:

Estimado padre:

Esta carta es para informarle que nombre de la escuela ofrece un programa educación bilingüe multicultural (BMEP por sus siglas de inglés). Los objetivos del programa son que todos los estudiantes sean bilingües y biculturales en inglés y una segundalenguaycumplirconlosestándaresdecontenidoacadémicodelestadoentodaslasmaterias.

El desarrollo cognitivo y afectivo de los estudiantes en el programa se fomenta mediante el uso de los antecedentes culturales y lingüísticos de los estudiantes, proporcionando a los estudiantes la oportunidad de ampliar sus capacidades y potencialidades conceptuales y lingüísticas de una manera exitosa y positiva, y enseñar a los estudiantes a apreciar el valor y la belleza de las diferentes lenguas y culturas. Su hijo/hija nombre del estudiante ha sido colocado en el programa de BME de laescuela.ElsiguientemodelodeBMEPseutilizaenelprograma:

Herencia—Diseñado para apoyar y revitalizar la lengua y la cultura nativa del estudiante a través de la enseñanza del idioma oral y/o escrito NMAC 6.32.2.12 (d)(3). Los estudiantes de inglés en este modelo recibirán una hora de artes del lenguaje en lenguaje de casa/patrimonio, y una hora de Inglés como segundo idioma .Los estudiantes inicialmente con fluidez en inglés en este modelo reciben una hora de artes del lenguaje en lenguaje de casa/patrimonio.

Se anima a los padres con niños que participan en el programa de la escuela a participar en el comité asesor de padres BME (BMEP PAC por sus siglas en inglés). Por favor, considere asistir a nuestra primera reunión de PAC programada para insertar la fecha. La participación de los padres en el desarrollo, implementación y evaluación del programa es valorado e importante ya que consideremos lo que funciona mejor para sus hijos y la comunidad.

Es muy recomendable que su hijo participe en, y reciba los beneficios de este programa. Sin embargo, usted tiene el derecho de rechazar la participación de su hijo/hija en del programa. Si tiene alguna pregunta, se le recomienda que llame o visite nuestra oficina.

Sinceramente,