TH JOHNSON ELEMENTARY

Documents needed with enrollment application(s): Documentos necesarios para cada solicitud de inscripción:

_______ Child’s Original Birth Certificate Acta de Nacimiento _______ Proof of Residence – Utility Bill or Lease Agreement Prueba de Residencia – Factura de Servicios Públicos/Contrato de Arrendamiento _______ Social Security Card Tarjeta de Número Social _______ Child’s current Immunization Records Cartulina de Vacunas _______ Parent ID/DL Identification Pre-K Students ONLY: _______ Proof of Income: Most Recent Pay Stub, Food Stamp Award Letter, TISD Lunch

Application Prueba de Ingresos: talón de cheque-más reciente, carta de elegibilidad de asistencia de comida de aplicación de comida de TISD

Registration Dates: May 14, 2015 3:30 PM to 7:00 PM July 29, 2015 10:00 AM to 6:00 PM August 10, 2015 10:00 AM to 6:00 PM

Meet the Teacher: Thursday, August 20, 2015 5:30 PM to 7:00 PM Conozca su Maestra: jueves, 20 de Agosto del 2015 5:30 PM a 7:00 PM

1st Day of school: Monday, August 24, 2015 1er Día de Escuela: lunes, 24 de Agosto del 2015

NEW STUDENT REGISTRATION FORM T.H. Johnson Elementary School

For Office Use: Entry Date: ________________________ Teacher: ________________________

ID #: ________________________

NAME: ________________________ _______________________ _____________________ ______ ________ First Middle Last Suffix Other

GENDER: ___Male ___Female GRADE LEVEL: _____________ DATE: __________________ BIRTHDATE: ____ /____ /____ SOCIAL SECURITY: ___________________________________ mo. day year

Student LIVES with which of the following: ____Both Parents ____Mother ____Father ____Legal Guardian FATHER _________________________________ MOTHER ________________________________

ADDRESS _________________________________ ADDRESS ________________________________

_________________________________ ________________________________

HOME # (_____) ______ - ___________ HOME # (_____) ______ - ___________ CELL # (_____) ______ - ___________ CELL # (_____) ______ - ___________ WORK# (_____) ______ - ___________ WORK # (_____) ______ - ___________ E-MAIL _______________________________ E-MAIL _____________________________ EMPLOYER _______________________________ EMPLOYER _____________________________ List SIBLINGS who are enrolled in TISD, who reside in the same household and are to be associated in the same family:

1. Name _____________________________________ Age:_______ DOB: ____________ Sex: M / F Grade: _______ 2. Name _____________________________________ Age:_______ DOB: ____________ Sex: M / F Grade: _______ 3. Name _____________________________________ Age:_______ DOB: ____________ Sex: M / F Grade: _______ 4. Name _____________________________________ Age:_______ DOB: ____________ Sex: M / F Grade: _______

HAS STUDENT EVER BEEN IN ANY OF THE FOLLOWING PROGRAMS? __Gifted __Special Education (Resource Classes) __ Special Education (Content Mastery)

__Section 504 __Title I __ESL/Bilingual __Speech Therapy __ Head Start

Has student ever been enrolled in a PRESCHOOL? (No) (Yes)...School Name: ______________________ Has student ever been enrolled in a TEXAS PUBLIC SCHOOL (No) (Yes)…School Name: ______________________

Has the student ever been retained? If yes, what grade ______________________________ Are there any legal documents pertaining to your child that we should be aware of? Yes _______ No ______ List any concerns you have that might affect or influence your child’s school performance or social adjustment. Please provide any information we may need to better assist your child.

04/2014

SCHOOL(S) and GRADE(S) LAST ATTENDED: ____________________________ _________________ _________________ ______________ School Name Telephone Number Fax Number Grade(s) ____________________________ __________________ ______ __________ _______-______ Address City State Zip Code Dates attended ============================================================================================

ONLY if your child will attend PK this school year, please fill out the following information:

Does the family receive any of the following: ___ Child Support ___WIC ___CCS ___ TANF ___Supplemental Security Income ___Food Stamps-SNAP Referred by Child Welfare Agency: ____YES ___NO Family Member Information: Primary Caregiver Adult Information. Also include other adults in the home:

D1-Education years completed D2-Employment Status (insert codes in the section marked D1): (insert codes in the section above marked D2) G09- Grade 9 or less HSG- High School Graduate F- Full-time G10- Grade 10 GED- GED P- Part-time G11- Grade 11 COL- Some College/Vocational/Associates Degree S- Seasonally Employed G12- Grade 12 CTG- College Degree or Trade School Certificate U- Unemployed D- Disabled BAD-Bachelors or Higher NHS- No High School T- In Training or School R-Retired Children in the household:

============================================================================= I understand that it is my responsibility to notify the school should any information change. I verify all of the information above to be true and accurate. ____________________________________ X____________________________________ ____________ Printed Name of Parent or Legal Guardian Signature of Parent or Legal Guardian Date

Full name and relationship to child:

(Mom, Dad, Grandparent, etc.) Sex: DOB: Language:

Ethnicity: Non-

Hispanic/ Hispanic

Race: (D1)

Education Status

(D2) Employer

Status

Name of employer and how long employed?

M F

M F

M F

Name of Child: Sex: DOB: Relationship to Child Enrolling:

M F

M F

M F

M F

M F

04/2014

T.H. Johnson Elementary School

3100 Duck Lane Taylor, TX 76574

Phone: 512-352-2275/512-365-7114

Fax: 512-365-7112

Jamie Haywood, Principal Andy Basche, Assistant Principal

HOME LANGUAGE SURVEY

CUESTIONARIO DEL IDIOMA QUE SE HABLA EN EL HOGAR

Taylor ISD would like you to take the time to answer this brief survey about the languages spoken in your home.

The purpose of this survey is to help with communication between the home and school and to ensure that your

child receives the most appropriate educational program to ensure their academic success.

Le gustaría al Distrito Escolar de Taylor se tome el tiempo de contestar este cuestionario sobre los idiomas que se

hablan en el hogar. El propósito de este cuestionario es para ayudar con la comunicación entre la casa y la escuela y

asegurarnos que su niño recibe el programa educativo mas apropiado para su éxito académico.

Sincerely/Sinceramente,

Mrs. Jamie Haywood

Principal/Director

Student’s Name ________________________________________________ DOB _________________ Grade _________________ Nombre de Estudiante FDN Grado

Please answer with the language that best answers the question.

Favor de contestar con el idioma que mejor contesta cada pregunta.

What language do you use the most to speak to your child? ¿Cual idioma usa usted la mayoría del tiempo para hablar con su hijo/a? English/Ingles Spanish/Español Other/Otro: _________________________ What language does your child use the most at home? ¿Cual idioma habla su hijo/a la mayoría de tiempo en casa? English/Ingles Spanish/Español Other/Otro: _________________________

_________________________________________________________________________________________________________

Signature of Parent/Guardian Date

Firma de Padre/Guardian Fecha

2015-2016 PEIMS Data Standards Appendix F: Ethnicity and Race Reporting Guidance

Exhibit 1A

Texas Education Agency Texas Public School Student/Staff Ethnicity and Race Data Questionnaire

The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff. This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC).

School district staff and parents or guardians of students enrolling in school are requested to provide this information. If you decline to provide this information, please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting.

Please answer both parts of the following questions on the student’s or staff member’s ethnicity and race. United States Federal Register (71 FR 44866)

Part 1. Ethnicity: Is the person Hispanic/Latino? (Choose only one)

Hispanic/Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Not Hispanic/Latino Part 2. Race: What is the person’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 a tribal affiliation or community attachment.

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.

________________________________

Student/Staff Name (please print)

________________________________

(Parent/Guardian)/(Staff) Signature

________________________________

Student/Staff Identification Number

________________________________ Date

This space reserved for Local school observer – upon completion and entering data in student software system, file this form in student’s permanent folder. Ethnicity – choose only one: _____ Hispanic / Latino _____ Not Hispanic/Latino

Race – choose one or more: _____ American Indian or Alaska Native _____ Asian _____ Black or African American _____ Native Hawaiian or Other Pacific Islander _____ White

Observer signature:

Campus and Date:

Texas Education Agency – March 2010

Hurricane Student: Yes/No

TAYLOR INDEPENDENT SCHOOL DISTRICT

Student Residency Questionnaire Name of Campus Name of Student Sex: □ Male Last First Middle □ Female Birth Date / / Grade: Social Security #: Month Day Year (or student identification number) This questionnaire is intended to address the McKinney-Vento Act 42 U.S.C. 11435. The answers to this residency information help determine the services the student may be eligible to receive. Is your current address a temporary living arrangement? Yes No Is this temporary living arrangement due to loss of housing or economic hardship? ____ Yes ______ No If you answered yes, how long have you been living in this arrangement: _________________ 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 the home of a friend or relative because I lost my housing (examples: fire, hurricane, flood, lost job, divorce,

domestic violence, kicked out by parents, parent in military and was shipped out, parent(s) in jail, etc.) In a shelter because I do not have permanent housing (examples: living in a family shelter, domestic violence

shelter, children/youth shelter, FEMA housing) Moving from place to place In a hotel or motel (examples: because of economic hardship, eviction, cannot get deposits for permanent home,

flood, fire, hurricane, etc.) In a tent, car, van, abandoned building, on the streets, campground, in the park or other unsheltered location

Name of Parent(s)/Legal Guardian(s) Address Zip Phone Presenting a false record or falsifying records is an offense under Section 37.10, Penal code, and enrollment of the child under false documents subjects the person to liability for tuition or other costs. TEC Sec. 25.002(3)(d). Signature of Parent/Legal Guardian Date Please send to John Matthews, Homeless Liaison, Taylor Main Street Campus, 3101 N. Main Street, Bldg. 910 Taylor, TX 76574 ( Phone: 512-352-1730; Fax 512-365-3800) I certify the above named student qualifies for the Child Nutrition Program under the provisions of the McKinney-Vento Act. Date McKinney-Vento Liaison Signature

03/11

Taylor ISD Employment Survey 2015-2016

Dear Parent(s), Only one completed survey per family is needed. It is not necessary to return a separate form for each child in your family. Your information is strictly confidential. It will not be shared or distributed. Child’s name Date of birth 1. 2. 3. 4.

If you have worked in temporary or seasonal jobs in agriculture or ranching; your child/children may qualify for supplemental services at school through the Migrant Education Program. Help us determine if your children are eligible for these additional services by answering a few questions and returning this completed survey to the school. Within the last 3 years (36 months), did you or one of your family members move to seek or find work in agriculture or fishing? ___YES (Continue completing the survey) ___NO (Stop and return the survey to the school)

_____Agriculture-Planting, harvesting fruits, vegetables, cotton, etc _____Ranches and farms—Caring for animals, mending fences, etc _____Fishing—Not recreational; work related to fishing, catching shrimp, etc. _____Processing plants-packing and processing meat, eggs, fruits, vegetables, etc _____Forestry—Planting trees and plants _____Other work related to agriculture__________________________________

When is the best day and time to contact you? Best day: ________________________ Preferred time: ________A.M _________P.M. _________________________________________Telephone_____________________ MOTHER’S NAME ______________________________________ _______________________________ Address City State Zip Code District contact:: Chris Wineland 3101 N. Main Street, Bldg. 910 Taylor, TX 76574

Fax 512 365-3800 Phone 512 352-1730