Fillable Lakewood Ranch High School Registration Checklist (School District of Manatee County)

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Lakewood Ranch High School Registration Checklist (School District of Manatee County)

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Lakewood Ranch High School
Registration Checklist
*CUSTODIAL PARENT/LEGAL GUARDIAN MUST ACCOMPANY STUDENT AT TIME OF ENROLLMENT*
Parents must supply the following at the time of enrollment for students who are:
• New to the State of Florida- Need items 1-10 listed below
• New to Manatee County- Need items 2-10 listed below
• Transferring/Re-entering from within Manatee county- Need items 3-10 listed below
1. PHYSICAL EXAMINATION – Current within the past 12 months.
2. FLORIDA CERTIFICATE OF IMMUNIZATION-
All PreK, KG, 7
th
&8
th
Grade or Student new to Florida schools must have proof of
immunization on the FL 680 form (Contact Manatee County Health Dept. 941-748-0747)
3. BIRTH CERTIFICATE or acceptable proof of age.
4. Legal GUARDIANSHIP papers if applicable.
5. Valid Florida DRIVER’S LICENSE of enrolling parent with current address.
6. PROOF OF RESIDENCY or Choice/Hardship Letter approved by OSA.
Must provide the following as proof of residency:
o Current electric/gas or water bill- with the matching address and name of the
parent/legal guardian receiving the service (NO other type of bill is acceptable).
o Current lease agreement/mortgage statement with parent/legal guardian’s name.
OR
o Notification of approval to enroll from the Office of Student Assignment (Choice,
Hardship, etc.)
7. WITHDRAWAL FORM from previous school. (If entering during school year)
8. COPY OF TRANSCRIPT and LAST REPORT CARD from previous school.
9. Child’s SOCIAL SECURITY CARD.
10. ENROLLMENT PACKET- Available on the Lakewood Ranch High School Website.
Manatee County School Enrollment Form
SCHOOL: _______________________________________________________________
Student Legal Name _________________________________________________________________________________ Grade Enrolling In ______
(As listed on Birth Certificate) Last Suffix (Jr, III, etc) First Middle
Any other legal name used _______________________________________________________________________________________________________
Residence address: _________________________________________________________________________________ Apt Bldg(specify)___________
_________________________________________________________________________________Home Phone (_____) ____________
City State Zip
Mailing address (if different): _____________________________________________________________________________________________________
Address Apt Bldg # City State Zip
Student resides at the above address with: □ * Other□ Out of Home/Foster Home*□ Father□ r Mothe□ Both Parents
____________________________________________________________________________________________________________________________________
*Explain (Appropriate guardianship documents MUST BE on file with School District)
_________________________________________________________________ /____________________________________________________________________
#1 Parent/Guardian e-mail address #2 Parent/Guardian e-mail address
Is student of Hispanic, Latino or Spanish origin? □Yes □No
Gender: □ Date of Birth (Month/Day/Year)____________/_________/_____________ Female □Male
Birthplace: City___________________________________State_________Country_____________ Social Security# _______/______/_______
Verification office use ______ (Section 1008.386 F.S.)
Race: (Check all that apply but must check at least one)
□White □Black or African American □Asian □American Indian or Alaskan Native □Native Hawaiian or Pacific Islander
Is student a child of a military family? □Yes (if yes, specify below) □No Residence On Base? □Yes □No
□Active duty □Medically discharged ___________ □Death in the line of duty _________
Discharge date Date of death
Did you move to Manatee County as a result of a hurricane/earthquake? □Hurricane _________________ □Earthquake □No
Did you move within Manatee County as a result of a hurricane/earthquake? □Hurricane _____________□Earthquake □No
Emergency Contact/Pick-up List (Only parties marked Y below are allowed to pick up child in emergency and non-emergency situations.)
(“*AC=Automated contact. Parties marked Y will receive non-emergency communications)
Name
Relationship
to student
Pick-up
(Y/N)
*AC
(Y/N)
Place of Employment
Work Phone
Cell Phone
Enrolling Parent/Guardian
Parent/Other
Other
Other
Other
Other
Brothers/Sisters in Manatee County Schools (Public, Charter, Private)
Name: ___________________________________________________________ Grade _____________ School __________________________________________
Name: ___________________________________________________________ Grade ____________ School __________________________________________
Enrolling Parent Signature _________________________________________________________________________ Date_________________________
Print First Name_________________________________________________ Print Last Name_________________________________________________
Verification office use
_____
______
Office use only Teacher __________________________
Entry code _____________Calendar __________________
ID#_______________________TEAM_________________
HR_________________CSL_________________________
Entry date: ________________Assignment code: _______
Transportation
□Walk □Bike □Car Rider □School Bus# _____ □Day Care: Name____________________________________Phone____________
MIS41-00463 Office of Student Assignment Rev 10-2014 Expires 10-2019
Page 2 Manatee County School Enrollment Form Name ___________________________________________________ Grade ______
Last School Student Attended:
School Name _____________________________________________________________________________ County:_________________________
Street Address__________________________________________________________ Phone (_____) ____________________________________
City, State, Zip________________________________________________________ Fax (_____) _________________________________________
Has student ever attended a Manatee County school before? If so, name of school __________________________________________________
Has student ever attended another Florida School? If so, name of school/City/County _______________________________________________
Has student ever repeated a grade? If so, which grade(s)___________
Has your student ever been or is your student currently in any of the following programs? Check the appropriate boxes.
Gifted
Specific Learning Disability
Emotional/Behavioral Disability
Orthopedically Impaired
Deaf or Hard of Hearing
Other Health Impaired
504 Plan
ESOL
Speech Impaired
Language Impaired
Visually Impaired
Traumatic Brain Injured
Dual Sensory Impaired
Autism Spectrum Disorder
Developmentally Delayed
Intellectual Disability
Occupational Therapy
Physical Therapy
Alternative Ed
(specify)___________________
Florida Statute 1006.07(1)(b) requires that you provide the following information:
Has the student been expelled (not suspended) from a school? □Yes □No
Has the student had an arrest resulting in a charge? □Yes □No
Has the student been involved in the Juvenile Justice System? □Yes □No
Has the student ever been referred for mental health services? □Yes □No
If the answer is YES to any of the above, please explain:
The next three programs have opportunities available, if qualifications are met.
(MUST ANSWER) Home Language Survey If yes, what language?
1. Is a language other than English used in the home? □Yes □No___________________________________
2. Does the student have a first language other than English? □Yes □No___________________________________
3. Does the student most frequently speak a language other than English? □Yes □No___________________________________
Answering “yes” to one or more of the Home Language Survey questions will require your child to be screened for English language proficiency and may
result in his/her eligibility for ESOL services.
If answered “yes” to any one of these questions, please indicate date student entered school in the U.S. for the first time (____/____/_____)
(MUST ANSWER)
Has parent/guardian moved within the last three years from another county/state due to working in agriculture, fishing, or dairy activities? □Yes □No
Student Housing Questionnaire- Project HEART- McKinney Vento Application
This questionnaire is intended to address the McKinney-Vento Act 42 U.S.C. 11435. The answers to this housing information help determine the
services the student may be eligible to receive.
1. Is your current address a temporary living arrangement? □Yes □No
2. Is this temporary living arrangement due to loss of housing or economic hardship?
□Yes □No
If you answered YES to the above questions, please complete the remainder of this form. If you answered NO, you may stop here.
Where is the student presently living? (Check one box.)
In a motel/hotel
In an emergency shelter (Salvation Army, Hope or Family Resources)
With more than one family in a house or apartment (parent/guardian not on lease)
Moving from place to place
In a place not designed for ordinary sleeping accommodations such as a car, park, or campsite
Required: Enrolling parent must read, sign and date this section.
Pursuant to section 837.06, Fl Statutes (2008), whoever knowingly makes a false statement in writing with the intent to
mislead a public servant in the performance of his/her official duty shall be guilty of a misdemeanor of the second degree.
I hereby certify that I have custody of my child at least 50% of the time and that I have read all information on this form
and that all answers I have given are true and correct.
Enrolling Parent Signature _________________________________________________________________________ Date_________________________
Print First Name_________________________________________________ Print Last Name_________________________________________________
To be completed by the school:
I, _____________________________, _______________________ @ ______________________ ES / MS / HS
print name print title name of school
have verified the social security # by visually checking the student’s social security card.
________________________ _____________
Signature Date
MIS Form 41-01136 Office of Student Assignment Revised 3-2016 Expires 3/2021
Collection of Student Social Security Numbers
Section 1008.386, F.S. requires school districts to request a social security number for each student in grades
PK-Adult who enroll or are enrolled in school. However, a student is not required to provide his or her social
security number as a condition of enrollment or graduation.
1008.386 Social security numbers used as student identification numbers.—Each district school board shall request that
each student enrolled in a public school in this state provide his or her social security number. Each school district shall use
social security numbers as student identification numbers in the management information system maintained by the school
district. However, a student is not required to provide his or her social security number as a condition for enrollment or
graduation. A student satisfies this requirement by presenting to school enrollment officials his or her social security card or
a copy of the card. The school district shall include the social security number in the student’s permanent records and shall
indicate if the student identification number is not a social security number. The Commissioner of Education shall provide
assistance to school districts to assure that the assignment of student identification numbers other than social security
numbers is kept to a minimum and to avoid duplication of any student identification number.
The collected social security number may be used for all or some of the following purposes:
1. Registration and tracking of students, including State Reporting
2. Local Accountability
3. FASTER
4. Migrant Tracking
Instructions: Please check one of the boxes below to indicate your choice, and complete the information at the
bottom of the form.
I will provide the school district with a copy of the above student’s social security card/number.
*If this information is provided, please give the parent a signed copy of this form for their records.
- -
Student’s Social Security Number
I will not provide the school district with a copy of the above student’s social security card/number.
I cannot provide the school district with a copy of the above student’s social security card/number.
Print Student Name Student Grade
Print Parent Name Parent Signature Date
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SUPERINTENDENT OF SCHOOLS
SCHOOL BOARD OF MANATEE COUNTY
BRADENTON, FLORIDA
REQUEST FOR STUDENT RECORDS
AND
VERIFICATION OF ENROLLMENT
Date of Request
TO: RECORDS DEPARTMENT
NAME OF SCHOOL _______________________________________________
ADDRESS _______________________________________________
CITY-STATE-ZIP CODE _______________________________________________
RE:
STUDENT
(Last)
(First)
(Middle Name/Initial)
Date of
Birth:
(Month)
(Day)
(Year)
(Grade)
PLEASE
FORWARD
RECORDS
TO:
Ms. Leota Walker
Lakewood Ranch High School
5500 Lakewood Ranch High School
Bradenton FL 34211
941-727-6100 ext. 2002
941-727-6129 Fax
walker2L@manateeschools.net
Include:
X
Student Grades/Transcript
X
Withdrawal Grades (if student left during current year)
X
Health Records (including physical and immunization records)
X
Grading Scale for your School
X
Test Scores
X
Exception Student Education Records (referral, eligibility/placement data and current IEP (FSP-preschool)
X
Psycho-Educational Evaluation, Social History, 504 Plan, other pertinent educational information
Parent’s Signature _____________________________________________ Date _________________________
FLORIDA STATE BOARD RULE: 6A-1.0955 (7b)
(b) The transfer of records shall be made immediately upon request of an adult student, a parent or guardian of a pupil or a receiving school. The principal
or designee shall transfer a copy of all Category A and Category B information and shall retain a copy of Category A information; however, student
records which are required for audit purposes for programs listed in Section 229.565(3), Florida Statute, shall be maintained in the district for the time
period indicated in Rule 6A-1513, FAC.
(c) The transfer of adult student or pupil education records shall not be delayed for nonpayment of a fee or fine assessed by the school.
PHONE: ________________________
FAX: ___________________________
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Lakewood Ranch High School Registration Checklist (School District of Manatee County)

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Completed 8 February 2021

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