bottom section is for school office to complete … · birth certificate (other types of valid...

EPIC NEW STUDENT ENROLLMENT FORM

2019– 2020 SCHOOL YEAR

STUDENT NAME ________________________________________________

DOB: ____/____/__________ GRADE __________

Forms needed to complete applica�on:

STUDENT ENROLLMENT FORM

MEDIA RELEASE FORM

HOME LANGUAGE SURVEY (required by CA law)

INFORMAL PRIMARY LANGUAGE SURVEY (if applicable)

CUMULATIVE RECORDS REQUEST FORM (if applicable)

Documents needed to complete applica�on:

BIRTH CERTIFICATE (other types of valid birthdate evidence accepted)

IMMUNIZATION RECORD (required by CA law)

BOTTOM SECTION IS FOR SCHOOL OFFICE TO COMPLETE

RECEIVED ON: _________________ ENROLLED ON: ________________

SPANISH RUSSIAN PRIORITY CODE

Enrollment priority code* based upon authorized charter: 1. (exis�ng EPIC Student) 2. (Children of EPIC Employee) 3. (all other applicants)

*Students are enrolled in this order as space becomes available in each class. If there is no space, students are placed on the waitlist based on priority code.

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Name: _____________________________________ Grade: ___________ Last, First (please print)

Home Room Teacher: _____________________________________

Core Classes: Mathema�cs, Science, Social Studies, English Language Arts,

Physical Educa�on, Music/Art, and World Language.

Policy: Empowering Possibili�es Interna�onal Charter is an Interna�onal Bacca-laureate School and it requires all students to receive instruc�on in at least one addi�onal world language. We believe that learning is best achieved when we commit to it for a length of �me, so once you have been placed in one world lan-guage course, you MUST stay in that language course for the school year.

World Language: Students must put 1st and 2nd choice. If there is no room in

their first choice, we will put them in their second choice of world language elec-�ve. _________ Russian ________Spanish

_________________________ _________________________ Student Signature Date Parent Signature Date

EMPOWERING POSSIBILITIES INTERNATIONAL SCHOOL

WORLD LANGUAGE ELECTIVE FORM

6th-8th Grades ONLY

(Students in TK – 5th grade take Russian ONLY)

MEDIA RELEASE FORM

I, _________________________________________ , the parent/guardian of ___________________________________________ , (student name) authorize EPIC school, Gateway Community Charters and IB to use my child’s picture in media coverage: print, video, website, and social media. It is my understanding that these materials can be used within the school, district and IB Organiza�on as well as for adver�sing purposes. Signed ___________________________________________ Parent/Guardian Signature Date: _____/_____/____________

EMPOWERING POSSIBILITIES INTERNATIONAL CHARTER


HOME LANGUAGE SURVEY Please answer all ques�ons on this form. Every student must have this form on file. Student’s Legal Name: __________________________ __________________________ Last First

Grade: ______ Birth Date: ____/____/________

What language did your child learn when he or she first began to talk? ___________________

(one language only)

What language does your child use most frequently at home? ___________________

(one language only)

What language do you use most frequently to speak to your child? ___________________

(one language only)

Name the language most o�en spoken by the adults in the home? ___________________

(one language only)

__________________________________________________________________ Was your child born in the United States of America? ____Yes ____No If No, then what country was your child born in? ________________________________ When did or will your child first enter a public or private school in the US? ____/____/______

Month Day Year

When did or when will your child first enter a public school in California? ____/____/______

Month Day Year

If your child was NOT born in the United States, please, answer the following ques�on: When did your child first come to the United States? ____/____/______

Month Day Year

____________________________________________ _____/____/_________ Signature of Parent/Guardian Date Signed

California Educa�on Code requires schools to determine the language(s) spoken in the home of all students. This informa�on is very important for providing adequate instruc-�onal programs and services.

Please answer the following ques�ons with only one language per line.


INFORMAL PRIMARY LANGUAGE SURVEY (ONLY complete if Home Language is NOT English)

Dear Parent: Your child is enrolled in EPIC school. When you filled out the Home Language Survey, you indi-cated that you, your child, or someone in your home spoke a language other than English. We would like to know more about your child’s skills in your home language.

Child’s Name: ________________________________________Grade: ________

EPIC School Date: _____/_____/________

Please circle or write in your answers:

SPEAKING & UNDERSTANDING Is your child able to understand almost everything that is said in his or her home language?

YES NO

What percentage of �me do you speak your home language to your child? (Circle One) 0% 25% 50% 100% What language does your child speak at home? _______________ English

Home Language

READING & WRITING Please check the box that best describes your child’s ability to read in the home language.

Does not read it Reads it a li�le Reads it well

Does your child write le�ers or messages to friends or rela�ves in the home language? YES NO

Please describe your child’s ability to write in the home language.

Does not write in it Writes in it some�mes Writes in it well

SCHOOL EXPERIENCE If you came to the United States from another country, did your child a�end school in that country? YES NO If you answered “YES” to the ques�on above, how many years did your child a�end school in that country? _________


CUMULATIVE RECORDS REQUEST FORM

Student Full Name: ___________________________________Birth Date: _________________

Last School A�ended: ___________________________________________________________

Dates A�ended: _______________________________________________________________

School Address: ________________________________________________________________

City, State: ___________________________________________ Zip Code: ________________

School Phone Number: (_____) ______________________ FAX: (_____) _________________

NOTE: If the last school was a�ended for less than one year, please give the name and address of the previous school a�ended: _____________________________________________________________________________ _____________________________________________ ___________________________ Signature of Parent/Guardian Today’s Date

_____________________________ To: School Registrar

The above named student has enrolled in EPIC as of _____/_____/__________.

If Applicable Please MAIL CELDT/ELPAC scores, CAASPP scores, IEP docu-

ments, Behavior Plans, SST informa�on to the address below. Please forward his/her cumula�ve records, test results, psychological and

health records, and any confiden�al or per�nent informa�on to the address below.

EMPOWERING POSSIBILITIES INTERNATIONAL CHARTER 2945 Ramco Street, Ste. 200 West Sacramento, CA 95691

(916) 286-1960 Phone [email protected] Email