FY2016-2017 WELCOME / BIENVENIDO STUDENT ENROLLMENT INSCRIPCIONES DE ESTUDIANTES
th
7 – 12
th
Please return to our office at 222 E. Olympic Dr. with the following documents: Copy of Birth Certificate, Immunization Records, Report Card, and Transcripts (Grades 9-12 ONLY). Por favor regrese a nuestra oficina 222 E. Olympic Dr. con los siguientes documentos: Copia de la acta de nacimiento, cartilla de vacunación, grados finales, y transcripciones (SOLO Grados 9-12)
New Federal Regulations For Race/Ethnicity Data The U. S. Department of Education (ED) is revising the way state education agencies & local education agencies are expected to maintain, collect, and report data on race and ethnicity. States will be required to report summarized data to ED using these new standards. The new standards are part of federal education reports that districts and states submit to receive funds such as those provided through the Elementary and Secondary Act (ESEA) and also are part of the required ED accountability reports collected through the EDFacts data collection system. Within ED, the Office of Civil Rights collects data at the school and district levels to assist with its enforcement of laws prohibiting discrimination on the basis of race and national origin, among other personal characteristics. Under the Individuals with Disability Education Act (IDEA), states are required to collect race and ethnicity data on students with disabilities. Data collected through the Office of Elementary and Secondary Education that account for progress in meeting the goals of the No Child Left Behind (NCBL) Act include information about students’ race and ethnicity. These are examples of data collections tied to federal funding that must comply with the new OMB guidance for collecting racial and ethnic data. The new race and ethnicity categories are also used by other federal agencies in civil rights, compliance monitoring and equal employment reporting for the public and private sectors, and for all levels of government. These racial and ethnic data standards have already been implemented by other federal agencies.
Changes in Regulations For Collecting Race/ Ethnicity Information Federal agencies have been working to implement the regulations adopted by the U.S., Office of Management and Budget since 1997, and the Department of Education is among the last to finalize adoption, making education data consistent with the Census data and other national data sets. Specifically, the major issue the federal government is trying to clear up is the distinction between race and ethnicity. The change will allow individuals the opportunity to select multiple races to more fully describe their heritage. The new regulations specify the following five race categories: American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
Please note that Hispanic/Latino/Mexican is considered an ethnicity, not a race. Realizing this is crucial to understanding the changes being made in terms of collecting
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data and reporting data. The Federal regulations specifically address how data will be collected by schools and districts. A two-part question—both parts of which must be answered—must be implemented for fall 2010 enrollments. (ADE highly recommends that the data be collected from all students and staff – not just new enrollees.) The order of the questions is important: Part A must be asked first, then Part B.
Part A: Is this student Hispanic/Latino? (Choose only one) No, not Hispanic/Latino Yes, Hispanic/Latino (A person who is Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin, regardless of race.) The above part of the question is about ethnicity, not race. No matter what you selected above, please continue to answer the following by marking one or more boxes to indicate what you consider your student’s race to be.
Part B: What is the student’s race? (Choose one or more) American Indian or Alaska Native (A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation Asian (A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.) Black or African American (A person having origins in any of the black racial groups of Africa.) Native Hawaiian or Other Pacific Islander (A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands.) White (A person having origins in any of the original peoples of Europe, the Middle East or North Africa.)
Race and Ethnicity Data Collection FAQ Questions parents and students may ask regarding the federal government’s new race and ethnicity data collection policy:
Q: Why is this information needed? A: In the last few decades, the demographics of our society have changed significantly. As a result, the Federal Government issued new race and ethnicity reporting categories which allow students and staff to describe who they are in a more accurate manner. This
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information is also used for funding and evaluation purposes, as well as civil rights compliance. Racial and ethnic data also aids in evaluating placement and program needs. The U.S. Census first utilized these new categories in 2000, Health agencies have completed adoption in their data collections. The Federal Equal Opportunities Commission (EEOC) began collecting data using these categories in 2007, and education will follow.
Q: Haven’t we provided this information before? Why do you need to ask again? A: The federal government is collecting this data in a different way. To ensure that everyone has the opportunity to identify him or herself more accurately, the data are being recollected.
Q: Will the school release my student’s race and ethnicity to other parties? A: No, individual student records are protected by the Federal Education Records and Privacy Act (FERPA). The new race and ethnicity categories have no effect on FERPA’s protection of student records. FERPA does not designate race and ethnicity as directory information, and race and ethnicity have the same protection as any other non-directory information in a student’s education record. This information will not be reported to any Federal agency in a way that would identify you or your child. No one will check immigration status from the information you give here, nor will your student be discriminated against in any way. However, the total number of students in each category of each school is reported to ensure schools are receiving the proper educational programs and services they need.
Q:Why do Hispanic/Latino students need to identify a race? A: The Federal Government recognizes the fact that members of Hispanic populations can be of different races. Marking a person’s ethnicity and race are two parts of one question. If the question is not answered completely, an observer must fill in the missing information on the person’s behalf.
Q: Can I refuse to provide this information? A: Yes, however, if one chooses not to provide such information, schools are required to provide an answer on one’s behalf.
How Will Schools Report to ADE? Schools and districts will report this data to ADE via ADEConnect and other student-level data collections in the same manner in which it was collected from the individual. Hispanic/Latino Ethnicity will be a Yes/No field and Race will be a separate field allowing one or more of the five racial categories to be reported. 3
What Does this Mean for Districts? It means that districts will need to change enrollment forms this winter/spring. Student Information System (SIS) vendors will need to modify their systems this spring. This should be done at no charge to districts. (Note: ADE has already been talking with SIS vendors regarding the changes.) District enrollment forms will need to implement the twopart question for all fall 2010 enrollees. Districts should plan to train staff to assist enrollees in responding to the two part question.
How Will Data Be Reported to the Federal Government and Public? When ADE reports the data to the Federal Government and to the public (via the Report Card), the data will be summarized and will include each individual in exactly one of the following seven categories: 1. Hispanic/Latino of any race For individuals who are non-Hispanic/Latino only: 2. American Indian or Alaskan Native 3. Asian 4. Black or African American 5. Native Hawaiian or Other Pacific Islander 6. White 7. Two or more races Individuals included in Hispanic/Latino will not be included in any other category for reporting purposes. This ensures that when assessment data are disaggregated, the assessment scores of Hispanic/Latino students will not also be in the racial category.
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ESPIRITU Community Development Corporation
Student Admissions Application - School Year 2016-2017 NFL YET College Prep Academy (7-12)
Application Date:
Last Grade Completed:
Application for Grade:
(Ultimo grado completado)
(Aplica para el grado)
Child's Legal Last Name (as it appears on legal document) / Apellido
First Name / Primer Nombre
Residence Address (proof of residency is required) / Domicilio
Middle Name / Segundo Nombre
Apt.#/Número de Apt.
City / Ciudad
Zip Code/Código Postal
Social Security #
Birth Date _________________ Age __________
Male
(Seguro Social)
(Fecha de Nacimiento)
(Masculino)
Female (Femenino)
/
Child's Place of Birth: Lugar de Nacimiento
(Edad)
City (Ciudad)
State (Estado)
Country (País de Nacimiento)
Please answer BOTH questions A & B. For this enrollment, Hispanic origins are not races. For questions, please see attached. Conteste por favor las preguntas A y B. Para esta inscripción, el origen hispano no son razas. Si tiene preguntas, por favor vea el adjunto. A. Is the child of Hispanic or Latino origin? ¿Es el niño de origen Hispano o Latino? Yes, Hispanic/Latino (A person who is Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin, regardless of race.) No, not Hispanic/Latino
B. What is the student's race? ¿Cuál es la raza del niño? (Choose One or More) White/Blanco
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
PHLOTE - Primary Home Language Other Than English - Home Language Survey / Idioma principal en el hogar excluyendo el inglés - Encuesta sobre el idioma en el hogar English/inglés
Spanish/español
Other Language (specify)/otro idioma
1. What is the primary language used in the home regardless of the language spoken by the student? ¿Cuál idioma se habla principalmente en su hogar sin considerar cuál es el idioma que habla el estudiante? 2. What is the language Most Often spoken by the student? / ¿Cuál idioma habla el estudiante con Mayor Frecuencia? 3. What is the language that the student first acquired? / ¿Cuál fue el primer idioma que aprendió el estudiante?
Parents/Guardian - Padres/Tutores: (
)
(
)
(
)
Mother Last Name, First Name
Home Phone
Work Ph.-Ext.
Cell Phone
E-Mail
Madre Nombre
Teléfono de Casa
Teléfono del Trabajo
Celular
Correo Electrónico
(
)
(
)
(
)
Father Last Name, First Name
Home Phone
Work Ph.-Ext.
Cell Phone
E-Mail
Padre Nombre
Teléfono de Casa
Teléfono del Trabajo
Celular
Correo Electrónico
Child lives with/Niño vive con?:
Father/Padre
Mother/Madre
Guardian
Other/Otro
Please list below all other children in this home - Por favor mencione el nombre de otros(as) niños(as) que vivan en su casa: Name/Nombre
Age/Edad
Grade/Grado
School/Escuela
Name/Nombre
Age/Edad
Grade/Grado
School/Escuela Mo
Last School Attended / Nombre de la(s) Escuela(s) Anterior(es)
Day
Year
City, State and Country/Ciudad, Estado y País Withdrawal Date/Fecha Dado de Baja en la Escuela
How Did You Hear About Us?¿Cómo se enteró de nosotros? Local Business/Empresas locales
Internet
Newspaper Ad/Aviso del Periódico
Front Office/Escuela de Oficina
Referral /Remision Nombre:
Signature of Parent or Guardian
Today's Date
Firma del Padre de Familia o Tutor
Fecha de Hoy
OFFICE USE ONLY Student ID: HmRm Teacher:
SAIS ID# McKinney-Vento:
Student Entry Date: Yes
No
Entry Code: Proof of Residency:
Birth Certificate
Grade Immunization
Withdrawal Form
PARENT/STUDENT PARAGRAPH Parent: In the space provided below, please tell us why you chose this school for your child/ren and what talents you will commit to the school. Please use the entire space to elaborate. Padres: En el siguiente espacio, por favor díganos porque escogió esta escuela para sus hijos, y a que se compromete usted aquí en la escuela. Por favor use todo el espacio.
Student: In the space provided below, please tell us why you chose this school, and what your goals are for your future. Also tell us what student activity you are interested in participating. Please use the entire space to explain. Estudiantes: En el siguiente espacio dinos porque elegiste esta escuela, y cuáles son tus metas para el futuro, y en cual actividades te gustaría participar. Por favor, utiliza todo el espacio.
By signing below, you acknowledge your commitment to your written statement above. Al poner tu firmar, estas afirmando lo que has escrito arriba.
Parent/Padre
Date/Fecha
Student/Estudiante
Date/Fecha
ESPIRITU Community Development Corporation
Photo Release Form
Dear Parent/Guardian: During the school year, our school will hold events that the news media and the district may like to feature. A representative may be on campus to gather photographs and/or video footage highlighting the event and featuring the faces of the ESPIRITU Schools. We value your child's participation, and ask for your permission to include him or her. Please indicate by checking the box(es) below whether your child has your permission to participate. You may update this form at any time by contacting our main office at (602) 243-7788.
Check All That Apply: I give my permission to have my child interviewed and photographed/videotaped by the news media. I give my permission to have my child photographed by the district. Photos may be used on school or district websites. I give my permission to have the district feature my child’s school work (e.g. art, essays, etc.). You may provide a credit to my child if his/her work is shown. First Name Only First & Last Name I give my permission to have my child videotaped by the district. Videos may be viewed by district staff or the public. Please do not include my child in these activities. I do not want my child photographed or videotaped. Comments:
Child’s name (please print) Parent/Guardian name (please print) Parent/Guardian signature
Date:
State of Arizona
Department of Education Office of English Language Acquisition Services
Primary Home Language Other Than English (PHLOTE) Home Language Survey (Effective April 4, 2011)
These questions are in compliance with Arizona Administrative Code, R7-2-306(B)(1), (2)(a-c).
Responses to these statements will be used to determine whether the student will be assessed for English Language Proficiency.
1. What is the primary language used in the home regardless of the language spoken by the student? 2. What is the language most often spoken by the student? 3. What is the language that the student first acquired?
Student Name Date of Birth Parent/Guardian Signature
Student ID SAIS ID Date
District or Charter School
-------------------------------------------------------------------------------------------------------------------------------------------Please provide a copy of the Home Language Survey to the ELL Coordinator/Main Contact on site. In SAIS, please indicate the student’s home or primary language. 1535 West Jefferson Street, Phoenix, Arizona 85007 • 602-542-0753 • www.azed.gov/oelas
Espiritu Community Development Corp.
Special Services Questionnaire
Last Name:
First Name:
SAIS #:
Student ID #:
Grade
Birth Date (DD/MM/YYYY):
Exceptional Student Services Survey Is the above named student:
Disciplinary History Questionnaire Is the above named student:
Currently receiving or qualifies for services under an Individual Education Plan (IEP)? Yes No
Currently suspended or being considered for Suspension? Yes No
Currently going through the Student Assistance Team Process (SAT)? Yes No Currently receiving or qualifies for services for Gifted and Talented Students? Yes No
Expelled from any school? Yes No Being considered for expulsion from any school or district? Yes No If yes, is the applicant under a condition imposed by juvenile court pursuant to A.R.S. Chapter 3 § 8-301 - 8-371 Yes No
HIGHLY CONFIDENTIAL DO NOT DUPLICATE AFTER COMPLETION
ESPIRITU Community Development Corporation “We form intellectual, virtuous, and loving Servant Leaders who form other leaders, who build spirit in their families and communities”
Dear Parent(s)/Guardian, This letter is in response to the questions and concerns we received in regard to the two forms Residency Affidavit and Migrant Questionnaire. Please understand the information we are seeking is for our records only and will be kept confidential. We would like to explain the importance of these two forms in greater detail. Each form will assist us in seeking Funding to provide a better education for your child, so it is very important that they are answered to the best of your knowledge. First form, Residency Affidavit. This questionnaire is intended to address the McKinneyVento Act. This form identifies our student’s living situation.
Example: Student Jane Doe currently lives with her parent and grandparents. Please note: Two families in the same home are immediately qualified under the “Doubled Up McKinney-Vento Act”. You will then check the box: Doubled Up - Student temporarily sharing the housing of other persons (Friends or Relatives) due to loss of housing, economic hardship, or a similar reason.
Second form, Migrant Questionnaire. This questionnaire is intended to address the Migrant Child Education Program. This form identifies if your child is eligible to receive services in a Migrant Program. We understand the current law within the State of Arizona raises many questions and concerns for our Parents. Please understand these forms have NO relation and will only be used to seek more funding for our schools. More funding for our schools means a better education for each of our children.
If you have any questions, please contact us at 602-243-7788.
Espiritu Community Development Corp.
Residency Affidavit
Date:
School:
Teacher:
Name of Student:
Grade Male
Date of Birth:
Female
Age:
Name of Parent(s) / Legal Guardian(s): Student lives with: Address: City:
Zip:
Phone:
Last School Attended: Last School Attended Address: This questionnaire is intended to address the McKinney-Vento Act. Your answers will help the administrator determine residency documents necessary for enrollment of this student. Presently, where is the student living? Check on box: Shelter - Student living in temporary shelters. Ex: Homeless Shelter, Domestic Violence Shelter, Transitional Housing Programs, or Temporary Foster Care Placements.
Doubled Up - Student temporarily sharing the housing of other persons (Friends or Relatives) due to loss of housing, economic hardship, or a similar reason. Unsheltered - Student living in abandoned buildings, campgrounds and vehicles, inadequate trailer parks, bus and train stations, substandard housing or abandoned in the hospital. Hotel / Motel - Student temporarily living in a hotel or motel due to lack of alternate adequate accommodations. None of the above apply. X
Date: Signature of Parent / Legal Guardian
OFFICE USE ONLY Student ID: Student Enrollment Date: McKinney-Vento: Yes No Yes, Date Entered into Schoolmaster
Initials
Espiritu Community Development Corp.
Migrant Questionnaire
Last Name:
First Name:
SAIS #:
Student ID #:
Grade
Birth Date (DD/MM/YYYY):
Migrant Student Services Survey During the last three (3) years, have you or your spouse worked in any of the following (Check all that apply): Commercial fishing or fish processing
Production of farm crops (field work, driving farm machinery, irrigation, etc.)
Fruit or Vegetable packer
Dairy, poultry or livestock farming Harvesting trees (seasonal nursery work)
1. Have you or your family moved recently or within the past three years?
Yes
No
2. Was the purpose of the move to work in the activities listed above, or any other related activities as a principal means of livelihood?
Yes
No
3. If Yes, may we contact you for further information?
Yes
No
Comentarios:
My Child has participated in the Migrant Child Education Program in the past:
Yes No X
Date: Signature of Parent / Legal Guardian
OFFICE USE ONLY Student ID: Student Enrollment Date: Entered in Schoolmaster: Yes, Date Entered:
Yes
No Initials
HIGHLY CONFIDENTIAL DO NOT DUPLICATE AFTER COMPLETION
School name:
Emergency Information and Immunization Record Card Child’s Name:
Updated:
Date Enrolled:
Home Address (#, Street, City, State, Zip):
Date Disenrolled: Date of Birth:
Home Phone:
Sex:
male
female
Mother or Guardian Name:
Home Address (#, Street, City, State, Zip):
Home Phone:
Cell Phone (optional):
Business Address (#, Street, City, State, Zip):
Business Phone:
Father or Guardian Name:
Home Address (#, Street, City, State, Zip):
Home Phone:
Cell Phone (optional):
Business Address (#, Street, City, State, Zip):
Business Phone:
I authorize the following individuals to collect my child from the facility if I cannot be located: Name:
Address (#, Street, City, State, Zip):
Phone:
Relationship: Name:
Address (#, Street, City, State, Zip):
Phone:
Relationship: Name:
Address (#, Street, City, State, Zip):
Phone:
Relationship: Name:
Address (#, Street, City, State, Zip):
Phone:
Relationship:
The following individual(s) may NOT remove my child from the facility: Name(s):
Custody papers have been provided and are on file at the facility.
yes
no
If Medical care is necessary, CALL: DOCTOR HOSPITAL
Name:
Address (#, Street, City, State, Zip):
Phone:
Name:
Address (#, Street, City, State, Zip):
Phone:
I hereby give authority to any hospital or doctor to render immediate aid as might be required at the time for his/her health and safety. It is understood by me that the expense of this service will be accepted by me.
In case of injury or sudden illness, I request that this individual be called first: Does your child have insurance coverage?
Telephone Authorization Code :
No
Yes
Name of Insurance Company:
(optional)
Immunization Information For information regarding current immunization requirements go to: www.azdhs.gov/phs/immun/index.htm or contact the Arizona Immunization Program Office at (602)364-3630.
One of these items must accompany the EIIR card at all times: Copy of current official documented immunization record attached Religious Beliefs exemption form signed by parent/guardian attached Medical Exemption form signed by physician and parent/guardian attached Signed Laboratory Proof of Immunity form attached Notification of immunizations needed sent to Parent(s) or Guardian(s):
Updated immunizations received and attached:
mo /day/ yr
mo /day/ yr
mo /day /yr
mo /day/ yr
mo /day/ yr
mo /day /yr
Medical Information Is child allergic to food or other substances?
No
Yes
Is child usually susceptible to infections and if so, what precautions need to be taken? If yes, list precautions:
No
Yes
Is child subject to convulsions and what should be our procedure if one occurs? If yes, specify procedure:
No
Yes
Is there any physical condition that we should be aware of and what precautions should be taken (heart trouble, foot problem, hearing impairment, hernia, etc.)? If yes, list precautions:
No
Yes
If yes, describe symptoms, name foods or substances to be avoided, and the procedure to follow if reaction occurs:
Additional comments:
Other special instructions:
This Emergency Information and Immunization Record Card is accurate and complete, front and back, and was provided by: Parent/Guardian PRINTED Name:
SIGNED Name:
G:\Forms\Emergency Information and Immunization Record Card (10/09)
DATE: