u n i v e r s al s c h ool...u n i v e r s al s c h ool 7350 w. 93r d st r e e t b r i dge v i e w ,...
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![Page 1: U n i v e r s al S c h ool...U n i v e r s al S c h ool 7350 W. 93r d St r e e t B r i dge v i e w , IL 60455 P hone : 708-599-4100 F ax : 708-599-1588 w w w .Un i v e r s al S c h](https://reader035.vdocuments.net/reader035/viewer/2022081521/5ec7d9995a099c78ef0b22cc/html5/thumbnails/1.jpg)
Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
FAMILY INFORMATION
Family Name Home Phone
Home Address City Zip Code
Mother's Full Name Birth Place Nationality Occupation
Cell Phone Work Phone Email Address
Father's Full Name Birth Place Nationality Occupation
Cell Phone Work Phone Email Address
STUDENT’S INFORMATION
F M CHILD’S NAME D.O.B. GRADE STUDENT EMAIL TUITION FEES TOTAL
1 ☐ ☐ $ $ $
2 ☐ ☐ $ $ $
3 ☐ ☐ $ $ $
4 ☐ ☐ $ $ $
5 ☐ ☐ $ $ $
TOTAL REGISTRATION AMOUNT: ☐ CHECK # ☐ CASH $
REMAINING BALANCE
Payment Plan (Smart Tuition): ☐ Full ☐ 3 Payments ☐ 4 Payments ☐ (10) Payments
Parent’s Signature: _____________________________________ Date: __________________
➢ Pr-K-7th Grade fees include the following: Registration, Standardized Tests, Books and Supply fees. ➢ 8th -12th Grade fees include the following: Registration, Standardized Tests, Islamic Studies and Arabic
Books. ➢ All High School Students, grades 8th-12th, will be required to purchase their own books. A complete list
will be provided @www.universalschool.org 1
NEW FAMILY REGISTRATION PACKET
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
All fees are Non-Refundable
Assessment Calculation
School’s operations and program is done through the collection of tuition, assessment and generous donations. Families are required to pay an additional assessment based on the family income.
(Check One for the Assessment Calculation)
FAMILY ANNUAL INCOME
$ 100,000.00 or less ☐
$ 100,001.00 - $ 125,000.00 ☐
$ 125,001.00 - $ 150,000.00 ☐
$ 150,001.00 - $ 175,000.00 ☐
$ 175,001.00 or more ☐
ASSESSMENT
Added to Tuition ☐
I will pay separately ☐
Fund Raising Participation: The board has adopted the following table of annual (or fund raising) fair share according to the level of the family income:
➢ Family with annual income of $100,000 or less ⇒ 0% of children’s tuition ➢ Family with annual income of $100,001 - $125,000 ⇒ 10% of children’s tuition ➢ Family with annual income of $125,001 - $150,000 ⇒ 20% of children’s tuition ➢ Family with annual income of $150,001 - $175,000 ⇒ 30% of children’s tuition ➢ Family with annual income of $175,001 or more ⇒ 40% of children’s tuition
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
Parent’s Signature: _____________________________________ Date: __________________
ACADEMIC PLACEMENT (For New Students Only)
In order to help the school to provide the best possible education for your children and others already enrolled, we must have basic information. Please answer the following questions to help us make the proper placement for your child. Name of child ______________________________________ Grade _______________ Has the child attended Islamic School? ☐No ☐Yes Name ____________Grade(s)_______
Name ____________Grade(s)_______ Type of Islamic School: ☐ weekend ☐ summer ☐ full-time Language Spoken at home?______________________________ Does child speak this language?__________ Read?☐ Write?☐ Does child speak Arabic?________ Read?☐ Write?☐ At the last school your child attended: Were special services required? YES ☐ NO ☐ Child received special education? YES ☐ NO ☐ If yes, list the type of service _______________________________________________ How many minutes a day or a week? _________________________________________ Do you have copies of the I.E.P? YES ☐ NO ☐ Has child received TESL? YES ☐ NO ☐ Has child received Bilingual education services? YES ☐ NO ☐ Was child in a regular program all day? YES ☐ NO ☐ Is there anything special we need to know to work better with your child? ______________________________________________________________________________
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
______________________________________________________________________________ ______________________________________________________________________________ Name of parent filling this form ___________________________________ _____________________________________ __________________ (Parent signature) (Date)
RELEASE FORMS
NAME OF STUDENT:_________________________________________________
(1) EMERGENCY MEDICAL CARE
I/We authorize Universal School staff or designated agent to secure Emergency Medical Care for my child when we cannot be reached at the time of emergency. I/We will be responsible for the medical charges incurred. The name, address and phone of my child’s doctor is on file at Universal. I understand that my child may be transferred to a nearby emergency facility by public safety officers or staff or agents of Universal School. _____________________________________ __________________ Parent’s signature Date Relationship to Child ______________________________________________
(2) TRIPS, EXCURSIONS, FIELD TRIPS, WALKING TO MASJID
I/We authorize Universal School, its staff or agents to take my child on walking trips, excursions, field trips and cross to the Masjid for prayer or lectures. I/We authorize my child to ride in any vehicle owned or leased by the school, its agents or staff. ___________________________________ __________________ Parent’s signature Date Relationship to Child ______________________________________________
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
(3) PHOTOGRAPHY
I/We authorize Universal School, its agents or staff to photograph or videotape my child for use in presentations, promotions, and educational activities without compensation. _____________________________________ __________________ Parent’s signature Date Relationship to Child ______________________________________________
Emergency Contact Information The Emergency Form is our direct line of communication to you when you are needed in an emergency. We thank you for remembering this and appreciate your help as we endeavor to serve you. Emergency Contact Information: An accident or extreme illness of a student makes it necessary for school personnel to contact the parent to get permission for emergency referral. The legal responsibility for medical and transportation expense incurred on behalf of your child is a parental one. By signing this form, you authorize first aid treatment using basic first aid supplies to be provided to your child as needed. In the event that a parent or Emergency Contact cannot be reached, you give permission for the School to arrange for necessary medical care. You understand and agree that you will be financially responsible for all aspects of such emergency medical care and you indemnify and hold the School harmless for all damages, claims, and amounts paid or due in connection with such emergency medical care. EMERGENCY CONTACT #1 Name: ________________________________________________________________ Relation: _________________________ Phone: _______________________________ Cell Phone: ______________________________________________________________ Address: ________________________________________________________________ EMERGENCY CONTACT #2 Name: ________________________________________________________________ Relation: _________________________ Phone: _______________________________ Cell Phone: _____________________________________________________________ Address: ________________________________________________________________
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
Release of Student Information: List below those persons authorized to take your child from School during the school day. If any person previously listed on this form is NO LONGER AUTHORIZED to take the student, please call the School’s Secretary where your child is enrolled PERSONS AUTHORIZED TO PICK UP STUDENT ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ _____________________________________ __________________ Parent’s signature Date
Parent Authorization and Permission for Administration of Medication
___________________________________ ____________________
Name of Student Grade
I herewith acknowledge that I am primarily responsible for administrating medication to my child. However, in the event that I am unable to do so or in the event of a medical emergency, I hereby authorize Universal School and its employees and agents, on my behalf and stead, to administer or to attempt to administer to my child (or to allow my child to self-administer, while under the supervision of the employees and agents of the School), lawfully prescribed medication in the manner described above.
I further acknowledge and agree that, when the lawfully prescribed medication is so administered or attempted to be administered, I waive any claims I might have against Universal School, its employees and agents arising out of the administration of said medication. In addition, I agree to hold harmless and indemnify Universal School, its employees and agents, either jointly or severally, from and against any and all claims, damages, causes of action or injuries incurred or resulting from the administration or attempts at administration of said medication.
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
I am requesting that the above named student take the following medication during school hours. ________________________________________________________________________ Name of Medication Type of Medication (Tablet, liquid or
capsule) ________________________________________________________________________ Dosage Time(s) to be given Possible Side Effects I will inform the school about any over the counter or prescribe medication that my child might be using later during any time in the school year. ________________________ Parent’s Signature
Student Allergy or Chronic Illness Information
Student Name_______________________ Grade ________ Contact _______________________
Home Number ______________________ Cell Number_________________________________
ALLERGY: Asthmatic/Respiratory Allergies Yes No *Higher risk for severe reaction Food Allergies Yes No *Higher risk for severe reaction
Detailed description of allergies: _________________________________________________________ TREATMENT:
For medications administered during school sanctioned activities, complete required Epipen/Twinject/Medication Authorization forms.
SYMPTOMS: ADMINISTER MEDICATION:
● If a food allergen has been ingested but no symptoms Epinephrine Antihistamine ● Mouth itching, tingling or swelling of lips, tongue or mouth Epinephrine Antihistamine ● Skin hives, itchy rash, swelling of the face or extremities Epinephrine Antihistamine ● Throat* Tightening of throat, hoarseness, hacking cough Epinephrine Antihistamine ● Lung* Shortness of breath, repetitive coughing, wheezing Epinephrine Antihistamine ● Heart* Pulse, low blood pressure, fainting, pale, blueness Epinephrine Antihistamine ● Other*________________________________________ ________________________________
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
DOSAGE: Epinephrine: inject intramuscularly (circle one) EpiPen® EpiPen® Jr. Twinject Antihistamine:______________________________________________________________________________ medication/dose/route
PLACE EMERGENCY CALLS 1. Call 911. State that an allergic reaction has been treated and additional epinephrine may be needed. 2. Dr’s Name: ________________________ Phone Number: ___________________________
EMERGENCY CONTACTS: Name Relationship Phone Number 1. ______________________________ _________________________ ________________________ 2. ______________________________ _________________________ ________________________ I give permission for school personnel to perform and carry out the task as outlined. I consent to the release of the information contained in this document to all staff members and others who have custodial care of my child and who may need to know this information to maintain my child’s health and safety. The school has notified parents and guardians in writing that, per 105 ILCS 5/22-30(c), the school and school personnel incur no liability for injuries occurring when administering asthma medication, an epinephrine auto-injector, or an opioid antagonist, and that the parents or guardians must sign a statement acknowledging this protection. ___________________________________________________ __________________________
Parent’s Signature Date
Medical Concern Form
Assalamu Aleikum Parents,
If your child has a medical concern that you think we should be aware of, please fill out the following information. This information will be shared with teachers so that they are aware of the needs that your child may have. Please realize it is pertinent for us to have this information in case of a medical emergency. Our intention is to provide the best for your child.
Thank you for your cooperation!
Name of the child: ________________________________________________________________________
Grade: ______________________________ Teacher: ____________________________
Medical Concern: _________________________________________________________________________
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
How frequent: _________________________________________________________________________
Causes: ___________________________________________________________________
Treatment: _________________________________________________________________
Any other comments: ___________________________________________________________________________
____________________________________________________________________________
I am aware that per School handbook “School personnel are not permitted to dispense medication to children. If the child cannot self-administer the medication, the parent, or an adult appointed by the parent, must come to school to administer the medication. Over the counter medicines, even cough drops, are not allowed without a note from the parent and signed consent of a physician. These may be held by the teacher or school office until needed at which time the child may self-administer.”
__________________________________________ __________________________ Parent’s Signature Date
STUDENT REQUEST FOR THE LOAN OF TEXTBOOKS
I hereby request the loan of school textbooks in accordance with Public Act 84-469 of 1981. I understand that this request will remain valid so long as my son/daughter is enrolled in Universal School and that I may at any time withdraw that request. __________________________________in ________________, __________ County Name of School town or city
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
______________________________ ________________________________ Student Student, Parent, Guardian
Arrival and Dismissal Procedures
Check this box if your children walk to and from school. However, you will still be issued a Car # in case it is needed at some point.
Child’s Name Grade Level
10
NEW FAMILY REGISTRATION PACKET
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
Walking to the Masjid for Salat
8th-12th grade
I am aware that my child will walk to the masjid for Salat Prayer
MORNING ARRIVAL Students may enter their classes at 8:10am from the North Doors. Students who arrive at 8am will wait in the vestibule until 8:10am. Drop off will take place at the North doors near Kg. Students should be in their classrooms and ready by 8:20am, so it is important that they arrive on time. If you have a scheduled meeting with a teacher, please park and sign in after 8:35am in the main office. If you need to inform your child’s teacher of an urgent matter, please send a message via Plus Portals, Remind 101, or the front office. ● In order to alleviate morning traffic and ensure a quick
drop off, Teacher Aides will assist children getting out of cars and will escort them to the door.
● PK-Kg grade teacher aides will meet students at the door and escort them to class.
● First through fifth grade students will walk directly to class
● Sixth and seventh grade students will report to the 2nd floor for assembly in the East Corridor
Arrival and Dismissal Procedures
● Pull all the way forward regardless of which door your student enters from. Do not stop at the office doors. Do not leave gaps. Do not get out of your car.
● Students should only exit the car on the passenger side. Back packs on for quick exit. ● Students arriving after 8:30 must enter from the front office doors.
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
● Teachers are unable to meet during morning arrival and dismissal
AFTERNOON DISMISSAL In order to maximize instructional time and maintain a safe school environment, no student may be checked out for early dismissal between 2:40-3:30pm (7th pd). Your cooperation is greatly appreciated. Parents may begin lining up in their zones by 3:15pm. Staff will be calling Car #s starting at 3:25pm. Please review and abide by Zone maps and routes. ● HS pick up is in the masjid parking lot, students will walk to your car. ● Your zones remain the same from last year. Street name is on your card above your number ● Odell Ave: #1-90, PK-1st family messengers (Pink Car#s) ● Octavia Ave: #91-244 Please Note: ● There is no early dismissal permitted between 2:40-3:30pm ● Do not use 92nd Pl to enter, that is an exit only ● Do not turn right onto Octavia during Arrival and Dismissal ● Do not use cell phones in school zones ● Watch for kids crossing the street ● Family messengers (oldest in family) received placards for Car # to place in front passenger window ● If you carpool, put both Car #s in front passenger window.
TRANSPORTATION
I __________________________________________ , the parent/guardian of ____________________grade _________, request Universal School to allow the following travel and pick up arrangements.
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
( ) Carpool with the following families 1- Name_____________________________ Phone _____________
Address _____________________________________________________ 2- Name_____________________________ Phone _____________ Address _____________________________________________________ 3- Name_____________________________ Phone _____________ Address _____________________________________________________ ( ) To ride with 1- Name_____________________________ Phone _____________
Address _____________________________________________________ 2- Name_____________________________ Phone _____________ Address _____________________________________________________ 3- Name_____________________________ Phone _____________ Address _____________________________________________________ ( ) Certain days and other specific information are listed here ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Information in this form must be updated by parents as soon as the change occur.
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
Dear parents of: __________________________________________________ In order to help the school carry out its mission of providing a quality academic and Islamic education as well as a safe environment for all students, all students must obey the rules of the school handbook. Please note the following rules concerning frequently asked questions by parents and/or students: 1. Students are advised to be in school by 8:20 a.m. H.S. must be in the gym for assembly by 8:20a.m,
Elementary in class by 8:20 a.m. Classes start at 8:30 a.m. Students coming late to school will serve detention for every four tardies per quarter.
2. If a student is ill or for any reason must stay home, a parent must call the school office at (708) 599-4100 between 7:30 and 8:00 a.m. (12:00 noon for afternoon absences). A Doctor or parent’s note must accompany the student the next day. If a student is absent for two or more days due to illness, only a physician’s note is required for re-admittance to school.
3. School dismissal time is at 3:30 p. m. Students are to be picked up on time. Parents who are unable to pick up their children on time are expected to be in contact with relatives, friends or emergency back up to take over the picking up of their children.
4. Students must have their lunch arranged before they come to school. The student will not be allowed to use the phone for lunch to be delivered or to receive lunch money. Any student coming to school without lunch will be given some crackers from the office to hold him/her through the end of the day.
5. Students are to be in uniform at all times during school hours. Students coming to school out of uniform will be sent home immediately.
6. Students are not allowed to use the school phone except in emergency situations. 7. Parents must arrange with the administration in advance if they wish to visit the classroom. Any
drop off or miscellaneous issues should be raised with the office so it would not interrupt the classroom instruction.
8. Changes of home or work phone number, address, emergency contact or emergency phone number should be made known to the office as soon as the changes occur.
9. All permission slips and expenses for field trips or other activities that require a signed permission from parents must be completed and sent with students. NO CHILD can attend without the required permissions and signatures. No exception will be made.
10. Parents are obligated to pay tuition, fundraising and other fees obligation. School policy requires that report cards, transcripts, test scores, and other academic records will be withheld, and students will not be allowed to graduate or take their final exams until all tuition and fees are paid in full. All delinquent accounts from previous years must be paid in full before a student is permitted to register for
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
the following school year. Failure to make payments will result in student being removed from the school. The School reserve the right to collect all balance thru any other available ways or means.
11. Other rules as stated in the school handbook or letters also apply. I have read and understood that the above rules will be enforced by Universal School staff to ensure the safe and educational environment of the School. __________________________ _______________ (Parent/Guardian Signature) (Date)
A copy has been kept in the student record TUITION AND FUNDRAISING ASSESSMENT AGREEMENT& GUIDELINES
I/We hereby register each child listed below for the grade level indicated. I agree to pay all charges in accordance with the tuition and fundraising assessment and fee schedule as attached hereto. You can choose 3 payment plans: 1. Plan A (3 payments): I agree to pay all sums as follows:
● Registration and book fees due at registration ● 1/3 Tuition due 8/10/19 to Smart ● 1/3 Tuition due 11/10/19 to Smart ● And balance of tuition and fundraising obligation due 2/10/2020.
2. Plan B (4 payments): I agree to pay all sums as follows:
● Registration and book fees due at registration ● 1/4 Tuition due 8/10/19 to Smart ● 1/4 Tuition due 11/10/19 to Smart ● 1/4 Tuition due 2/10/20 to Smart ● And balance of tuition and fundraising obligation due 4/10/2020.
3. Plan C (10 Monthly payments): I agree to pay all sums as follows:
● Book fees and registration fees are due at time of registration ● Monthly payment by the 10th of each month starting August 10th ● Fundraising obligation by November 10th, 2019 ● Balance of tuition must be paid by May 10th, 2020
I agree that I am obligated to raise funds from ticket sales and donations no less than an amount equal to 10%, 20%, 30%, or 40% of my child/children’s tuition, depending on my gross income. This sum will be added to my children’s tuition if not raised at the time of the fundraising dinner. (Subject to Universal School Board review and approval).
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
I acknowledge that failure to make payments when due will result in my child/children's being removed from Universal School. Students' records will be withheld for none payment. STUDENT’S NAME(S) GRADE ● ___________________________________________________________________
● ___________________________________________________________________ ● ___________________________________________________________________ (Parent/Guardian Signature) (Date)
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
Orphan Support Fund Information
2019-2020 The Orphan Support Fund was created by the Fathers' club, to raise money for current Universal School students whose parent(s) passed away when the students were already enroll at Universal School. This fund will be covering the student's tuition expenses for the time he/she is attending Universal School with generous support from caring families like yourselves, these students will have the guarantee of an Islamic School education until they graduate. We are asking for your cooperation by donating to this fund to make this effort possible.
Please check the amount that you are willing to donate: $ 10 ☐ Pay at registration ☐ Include in my tuition ☐ $ 20 ☐ Pay at registration ☐ Include in my tuition ☐ $ 30 ☐ Pay at registration ☐ Include in my tuition ☐ $ 50 ☐ Pay at registration ☐ Include in my tuition ☐ $ 100 ☐ Pay at registration ☐ Include in my tuition ☐ Other ☐ $ ______ Pay at registration ☐ Include in my tuition ☐ Any donation towards this fund is tax deductible and a donation receipt will be issued to you for tax purposes.
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
School Records Release TO THE PARENTS OF THE APPLICANT
Please complete this school records release form and return it with your completed application. STUDENTS NAME Grade
I GRANT PERMISSION TO THE PROPER AUTHORITIES AT: _____________________________________ NAME OF APPLICANT'S CURRENT SCHOOL _____________________________________ ADDRESS
_____________________________________
YOUR SCHOOL IS AUTHORIZED TO FORWARD ALL RECORDS TO UNIVERSAL SCHOOL
PLEASE FORWARD THE FOLLOWING RECORDS
☐Academic Records ☐Record of extracurricular activities ☐Attendance Records ☐ Standardized Achievement Test scores ☐Health Records/Certificates ☐ Teacher and/or counselor observations & comment ☐I.E.P Reports (Individualized Educational Program) ☐Other ______________________________________
PLEASE CHECK ALL THAT APPLY TO THE YOUR CHILD: Is your child receiving any of the following special programs?
☐ Special Education ☐ 504 Plan ☐ Bilingual/ESL/Limited English ☐ At-Risk ☐ Dyslexia ☐ Speech ☐ Title I Has your child ever been retained? ☐ Yes ☐ No If yes, what year? _______________
18 NEW FAMILY REGISTRATION PACKET
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
SIGNATURE _________________________________ _________________
SIGNATURE OF PARENT OR GUARDIAN DATE
PLEASE SEND Universal School RECORDS TO Attention Registrar
7350 W. 93rd Street Bridgeview, IL 60455
DEPARTMENT OF DEFENSE EDUCATION ACTIVITY ESL Home Language Questionnaire
Privacy Act Notice: Authority to Collect Information: 20 U.S.C. 927(c) and 10 U.S.C. 2164(f), as amended; E.O 9387; the Privacy Act of 1974, as amended, 5 U.S.C. 552a. Principal Purpose: The information will be used within the DoD to determine the services to be provided to a student to assist the child to receive a free appropriate public education. Disclosure to the Agency of the information requested on this form is voluntary; but failure to provide all requested information may result in the delay or denial of student services. DoDEA may disclose information requested in this form to other DoD activities and contracted service providers who require the information to deliver educational services to the child and for valid medical, law enforcement or security purposes, or for use in litigation concerning the delivery of student. Routine Uses: Disclosure of information contained in this form is authorized outside the DoD in accordance with the “Blanket Routine Uses” described at the beginning of the Office of the Secretary of Defense’s compilation of systems of records notices, published at ttp://www.defenselink.mil./privacy/notice/osd.
THIS FORM IS COMPLETED AT THE TIME OF STUDENT ENROLLMENT Child’s Name: _______________________________________ Date: ____________________ Grade: _______ Date of Birth: _______ Age: _________________________ 1. What language is commonly spoken in your home? ___English ___ Another Language (Please specify):__________________________________
2. Does the child you are registering speak a language other than English? (Excluding foreign languages studied in school.) ____ No ____ Yes If yes: What language is spoken? __________________________________
3. What language did your child use when he/she first began to talk? ___English ___ Another Language (Please specify)____________________________________
4. Has your child attended English speaking schools? _____ No _____ Yes If yes: How many years? ______________________________________
5. What language does your child read and/or write? ___English ___ Another Language (Please specify)___________________________________
6. What language do you most often use when speaking with your child? ___English ___ Another Language (Please specify)_________________________________________ 7. What language does your child use most often when speaking to you?
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
___English ___ Another Language (Please specify)___________________________________
8. If your child is cared for by another person on a regular basis, what language is most often used? ___English ___ Another Language (Please specify)____________________________________ 9. Do you as a parent need to communicate with the school in a language other than English? ______ No ______ Yes If yes, in what language?_____________________________________ Continued on the next page DoDEA ESL Program Form F4 (BACK), March 2007 ESL Home Language Questionnaire (cont.) If based on the results of this questionnaire it is necessary to conduct an evaluation, I understand and give my permission for: 1. My child to be evaluated using a standardized language proficiency test and/or academic achievement test to determine whether he/she is eligible for English as a Second Language (ESL) services. Additional information may be collected from my child’s teacher(s) and his/her school records.
AND 2. Annual Spring testing to measure my child’s academic and English language progress if eligible for services. I understand that the ESL Teacher will share the results of the assessments with me when testing is completed. ________________________________ _______________________ Parent Signature Date
To be completed by ESL Teacher ONLY: Recommendation: ____ Proficiency Testing ___ Records Review ___ No ESL Services Required Signature of ESL Teacher: ___________________________ Date: ___________________
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NEW FAMILY REGISTRATION PACKET
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
Distribution: Original to Student’s Cumulative File, Copy to ESL Teacher
Illinois State Board of Education New U.S. Department of Education Race and Ethnicity Data Standards
SAMPLE DATA COLLECTION FORM
Note: The student’s parents or guardians should respond to both questions (Part A and Part B). If the parents or guardians decline to respond to either question (Part A or Part B), school district staff are required to provide the missing information by observer identification. Student’s Name: SIS ID: (pre-printed by school district) (pre-printed by school district) INSTRUCTIONS: This form is to be filled out by the student’s parents or guardians, and both questions must be answered. Part A asks about the student’s ethnicity and Part B asks about the student’s race. If you decline to respond to either question, the school district is required to provide the missing information by observer identification. Part A. Is this student Hispanic/Latino? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.) Choose only one.
□ No, not Hispanic/Latino □ Yes, Hispanic/Latino
The question above is about ethnicity, not race. No matter which answer you selected, continue and respond to the question below by marking one or more boxes to indicate what you consider this 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 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.)
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
□ White (A person having origins in any of the original peoples of Europe, the Middle East, or North
Africa.)
Note: Data collected on this form must be maintained by the school district for three years. However, when there is litigation, a claim, an audit, or another action involving this record, the original responses must be retained until the completion of the action. Illinois State Board of Education, Division of Data Analysis and Progress Reporting December 2009
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
Step 1: Create password
➢ Once your registration is complete, you will receive an email from Universal School: Plus portals User Account Activation Details
➢ Click on the link to create a password. You will be taken to the following screen ➢ Username: (your email) ➢ Password must have a capital letter and #
Step 2: Login to portal
➢ Go to www.plusportals.com/UniversalSchool
Step 3: View Tutorials
➢ Check out the help menu to view more tutorials that will help acquaint you with checking grades, discipline, and messaging teacher
Step 4: Download APP
➢ Download the Parent Plus APP to your phone for faster access to your portals. Search Rediker in your APP Store.
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
Step 1: Go to
➢ myschoolaccount.com ➢ Click on create account tab on the top right corner. ➢ Please enter the required personal information to create your parent account
Step 2:
➢ Create a UserID and Password to access your parent account. Step 3:
➢ Select the school district where your children attend school ➢ Universal School (IL). ➢ Then click I accept the terms of the User Agreement
Step 4:
➢ Please verify the information An email will be sent to your email address immediately after you press "Finish
Step 5: ➢ An email sent to you containing the verification code. Please enter the code to verify that you are able to
receive email from us and activate your account. Step 6:
➢ Click on manage students ➢ Now you can manage your child account
Step 7:
➢ Click on add student Step 8:
➢ Enter student ID you received from school then click add ➢ Repeat for all your children
Step 9:
➢ Click on deposit fund tab to add money to the account
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
Question’s Contact Mrs. Karim @ 708-599-4100 x326 or Email @ [email protected]
SMART TUITION GENERAL ENROLLMENT INSTRUCTIONS
Your School has partnered with Smart Tuition to service your child’s tuition account. To enroll online, please follow the instructions below:
➢ ONLINE ENROLLMENT Visit: www.enrollwithsmart.com
1. WELCOME TO ENROLL WITH SMART Click on the blue box, Create a New Account.
2. FIND YOUR SCHOOL Enter your school’s name in the search box. Make your selection by clicking the green circle.
3. SECTION 1 – WHO WILL PAY? Enter the parent, guardian, or bill payer’s contact information. Please provide your telephone number and email address as Smart Tuition regularly communicates important information about your account via telephone and email.
4. SECTION 2 – WHO WILL ATTEND? Enter the names and grades of the children who will attend the school. If you already have a child in this school with a Smart Tuition account, simply add any additional children to your existing account by going to enrollwithsmart.com and enter your current account information under I Have A Smart Account.
5. SECTION 3 – HOW & WHEN TO PAY? Review the payment plans offered by your school and choose one. The payment plans listed are selected by your school and cannot be changed by Smart Tuition. Select your preferred payment method and due date from the options offered by your school.
6. SECTION 4 – SUBMIT Review Smart Tuition’s terms and conditions. Click SUBMIT ENROLLMENT to complete your online enrollment. REGISTRATION APPLICATION SUCCESSFUL You will receive a confirmation page with your Smart Tuition Family ID. Your school will then review your enrollment, and once complete, you will receive confirmation from Smart Tuition.
ACCOUNT ACTIVATION Once your school has reviewed and activated your account, you will receive an email with login instructions.
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Universal School
7350 W. 93rd Street ♦ Bridgeview, IL 60455 Phone: 708-599-4100 ♦ Fax: 708-599-1588 ♦ www.UniversalSchool.org
NEW STUDENT(S) REGISTRATION FORM 2019-2020
Mrs. Hanan Abdallah, Principal
To view your balance, make payments, update your personal information, or chat with a live representative, access your Smart Tuition account at parent.smarttuition.com.
The Smart Tuition program manages tuition payments and follows the policies established at the school. Decisions regarding tuition amounts, tuition aid, scholarships, and all other tuition related items are made by your school.
PAYMENTS CAN NOW BE MADE AT THE FOLLOWING LOCATIONS:
Question’s Contact Mrs. Abed @ 708-599-4100 x324 or Email @ [email protected]
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