Meadows Union School District STUDENT INFORMATION: (Información del Estudiante)

2059 Bowker Road, El Centro, CA 92243 (760) 352-7512; fax (760) 337-1275 M___ F___

Grade______

Name:__________________________________________________________________ (Nombre del Alumno)Last (appellido) First (1er.) Middle (2do) Address: ________________________________________________________________ (Domicilio)

City:________________________________________State:_______Zip Code:________ (Ciudad)

(Estado)

Phone: ________________________________Cell:______________________________ (Telefono)

SCHOOL USE ONLY (Uso escolar) School Year ________________________ Local ID#__________________________ SSID#_____________________________ US School Entry_____________________

(Telefono de celular)

(Do not include pre-school)

Date of Birth:____________________Age:_____Birthplace:_______________________ (Fecha de Nacimiento)

ENROLLMENT FORM

(Edad)

(Lugar de nacimiento)

Court restraining orders?____Yes? Need a copy of restraining orders. (Se encuentra orden

Original Entry Date___________________ Teacher______________________________ Grade_______________Room____________ Bus #: AM _______ PM _________

de restriccion legal? Si? Explique___________________________________)

Language of Correspondence (Correspondencia?)

English (Ingles)

Spanish (Español)

What is your child’s ethnicity?(Etnecidad de su hijo(a)) Hispanic/Latino Not Hispanic What is your child’s race? (Cual es la raza de su hijo(a)?) ___________________________ Parent Education Level:

School History / District Identify attended school/city: (Identifique escuela que asistio y la ciudad) K_________________________________ 1st _______________________________ 2nd_______________________________ 3rd _______________________________ 4th________________________________ 5th________________________________ 6th________________________________ 7th________________________________ 8th________________________________

Check the response that describes the education level of each parent. (M: mother/F: father) (Marque el nivel de educacion de cada padre.) M/F Graduate degree or higher (10) (maestria/doctorado) M/F College graduate (11) (graduado de colegio/Universidad) M/F Some college or AA degree (12) (algunos cursos de colegio hacia un titulo) M/F High school graduate (13) (graduado de prepa) M/F Not a high school graduate (14) (No completó la prepa) Parent’s email address: (correo electronico): M/F Declined to state or unknown (15) (no declaró el nivel)

______________________________________________________________________

PARENT/GUARDIAN INFORMATION: (Información de Padre/Tutor) __ Occupation/Place of Employment Relationship Name (Nombre)

Work phone (Tel. en el trabajo)

(Oficio/Lugar de Empleo)

(Relación)

Father/Guardian

Living w/ (Viven con)

Yes

No

Yes

No

Yes

No

(Padre/Tutor)

Mother/Guardian (Madre/Tutor) StepParent/Foster/Other

(Padrastro/otro)

CHILDREN IN THE FAMILY: (Niños en la familia) Name of the child (Nombre del niño(a))

Birthdate(fecha de nacimiento)

Relationship (relación?)

At home? (en casa?)

School grade if attending (que grado si asiste la escuela)

EDUCATIONAL PROGRAMS: (Programas Educativos) 1. Has your child been retained? (Ha reprobado?)_____What grade? (Que grado?)_____What school? (Cuál escuela?) ____________________ 2. Are confidential reports available from your child’s former school? (Hay archivo confidencial en previa escuela de su hijo(a)? __Yes __No a. Special Education? SDC/RSP/Speech (Educacion Especial?Terapia del Habla?) _____Yes ____No. If yes, then provide a copy of latest IEP paperwork. (Si, entonces provee una copia del IEP de su hijo/a.)_____________________________________________________________

3. Has there been a change of residency in the last 3 years? (Hubo cambio de residencia en los ultimos 3 años?) ____Yes ___No. If yes, then complete survey for possible Migrant Education services eligibility. 4. Other needs: (Otras necesidades)______________________________________________________________________________________________ SIGNATURE **The information on this form is true and correct. (La informacion en esta forma es veridico y correcta.) **I give my consent for the above named student to take part in field trips, community-based instruction and other student activities sponsored by Meadows Union School/Imperial County Office of Education and photos taken related to school activities. (Yo doy mi consentimiento para que el alumno tome parte en excursiones para la instrucción y otras actividades para alumnos patrocinadas por Escuela de Meadows Union y Oficina de Educación del Condado Imperial y la toma de fotografías relacionadas con actividades escolares.). Parent/Guardian Signature;_______________________________________ Date: _____________