Welcome to the

Wilmington Area

School District

Enrollment Packet

Jeffrey A. Matty, Ed.D. Superintendent

(724) 656-8866

www.wasd.school

Education Is Our #1 Priority

The information in this enrollment packet is a brief look at the district. You will receive additional information the first week of school. Please fill out the forms included in this packet and return them to Mrs. Carolyn Huff or Mrs. Melda Irwin at the District Administration Office. If you have any questions regarding the enrollment process, feel free to contact either Mrs. Huff at (724) 656-8866 x 6000 or Mrs. Irwin at (724) 656-8866 x 6100. You may also visit the website at www.wasd.school for additional information.

Overview

The Wilmington Area School District is located in the northern portion of Lawrence County and part of Mercer County. It consists of the following townships and boroughs: Washington Township, Plain Grove Township, Wilmington Township (Mercer and Lawrence Counties), Pulaski Township, Volant Borough and New Wilmington Borough. The district has an elementary school, a middle school and a high school. The enrollment is approximately 1150 (Gr. K-12).

Building Information

Wilmington Area School District 300 Wood Street

New Wilmington, PA 16142 Phone: (724) 656-8866 x 6000

FAX: (724) 946-8982

Business Hours: 8:00 a.m. – 4:00 p.m.

Title Name Email Phone

Extension

Superintendent Dr. Jeffrey Matty matty@wasd.school 6000

Business Manager/ Board Secretary

Mr. Joshua Latore latore@wasd.school 6200

Special Education Supervisor

Miss Mary Anne Grubic grubic@wasd.school 6502

School Psychologist

Dr. Michael O’Donovan odonovan@wasd.school 6504

Director of Curriculum & Instruction

Mr. Ken Jewell jewell@wasd.school 6600

Food Service Director

Mr. Ed Freer freer@wasd.school 6075

Enrollment Secretary

Mrs. Carolyn Huff huff@wasd.school 6000

Enrollment Secretary/ Volunteers/ Clearances

Mrs. Melda Irwin irwin@wasd.school 6100

Wilmington Area Elementary School (Gr. K-4) 450 Wood Street

New Wilmington, PA 16142 Phone: (724) 656-8866 x 3000

FAX: (724) 946-8259

Start Time: 9:00 a.m. – Dismissal Time: 3:45 p.m.

Title Name Email Phone

Extension

Principal Mr. Robert Kwiat kwiat@wasd.school 3010

Special Education Supervisor

Miss Mary Anne Grubic grubic@wasd.school 6502

Guidance Mrs. Valerie Lewis lewis@wasd.school 3020

Nurse Mrs. Anna Daugherty daugherty@wasd.school 3030

Secretary Mrs. Marlene Hauger hauger@wasd.school 3000

Secretary Mrs. Julie Shenker shenker@wasd.school 3001

Wilmington Area Middle School (Gr. 5-8) 400 Wood Street

New Wilmington, PA 16142 (724) 656-8866 x 2000

Start Time: 7:45 a.m. – Dismissal Time: 2:35 p.m.

Title Name Email Phone

Extension

Principal Mr. George Endrizzi endrizzi@wasd.school 2010

Special Education Supervisor

Miss Mary Anne Grubic grubic@wasd.school 6502

Guidance Mrs. Kim Telesz telesz@wasd.school 2020

Nurse Mrs. Sarah Vincent vincent@wasd.school 1030

Secretary Mrs. Paula Woods woods@wasd.school 2000

Wilmington Area High School (Gr. 9-12) 350 Wood Street

New Wilmington, PA 16142 (724) 656-8866 x 1000

Start Time: 7:45 a.m. – Dismissal Time: 2:35 p.m.

Title Name Email Phone

Extension

Principal (Gr. 9-12) Mr. Michael Wright wright@wasd.school 1010

Special Education Supervisor

Miss Mary Anne Grubic grubic@wasd.school 6502

Guidance Ms. Taryn Powell powell@wasd.school 1020

Guidance Secretary Mrs. Becky Hoppe hoppe@wasd.school 1001

Nurse Mrs. Sarah Vincent vincent@wasd.school 1030

Athletic Director Miss Brandy Sanford sanford@wasd.school 1050

Secretary Ms. Connie Cassella cassella@wasd.school 1000

Secretary Ms. Mary Saterlee saterlee@wasd.school 1021

Transportation Contacts

.

Title/Company Name Email Phone

Transportation Coordinator

Mrs. Melda Irwin irwin@wasd.school (724) 656-8866

ext. 6100

Krise Transportation, Inc. (Busing)

Mr. Earl Hogue ehoguejr@krisetran.com (724) 901-7126 (724) 901-7129 (724) 977-3632

WILMINGTON AREA SCHOOLS

ENROLLMENT OF NEW PUPILS ═══════════════════════════════════════════════════════════════════════ Pupil's Name Sex M F (Last) (First) (Middle) Address (Street/Road/PO Box)

City State Zip Telephone

Township/Boro: Pulaski Twp. Wilmington Twp. Volant Boro New Wilmington Boro Washington Twp. Plain Grove Twp.

County: Lawrence Mercer

Date of Birth Birth Certificate No.

Place of Birth (Name of Hospital) (City) (State)

*If your child was born outside of PA, list date they first resided in PA: (mm/dd/yyyy)

Ethnicity: 1. Amer. Indian/Alaskan Native (not Hispanic) 3. Black or African American (not Hispanic) 4. Hispanic (any race) 5. White (not Hispanic) 6. Multi-Racial (not Hispanic) 9. Asian (not Hispanic) 10. Native Hawaiian or other Pacific Islander (not Hispanic)

Living with: Mother Father Both Guardian Foster Other

═══════════════════════════════════════════════════════════════════════ Father Guardian Foster Information (circle one)

Name Last First M.I. Address City State Zip Home Telephone Cellular Telephone Occupation Employer Work Telephone Email Address

Mother Guardian Foster Information (circle one) Mrs. Ms. Miss Name Last First Maiden Name Address City State Zip Home Telephone Cellular Telephone Occupation Employer Work Telephone Email Address

Step Father: Step Mother

═══════════════════════════════════════════════════════════════════════ Are there any court documents regarding your child? Yes No CUSTODY PAPERS ON FILE – Date Other children in the family or living at the above address:

NAME (First and Last) SEX DATE OF BIRTH SCHOOL GRADE RELATIONSHIP

Last School Attended: Grade

School Address: Telephone: ( )

City State Zip Date of Withdrawal:

Previous Schools attended: Parent/Guardian Signature Date

═══════════════════════════════════════════════════════════════════════ For Office Use Only

Resident/Non-Resident Information (Check all that apply) Entry Information – Must be mm/dd/yyyy format only.

PA Secure ID # Grade Homeroom/Teacher Student Number Locker Number

Required for all students

Grade 09 Entry Date __________

District Entry Date ______________

School Entry Date __ ___________ _

State Entry Date

Only if student is an immigrant, migrant or ELL:

Date Entered School in USA

Years in US School

Please print in blue or black ink.

1306 1305 Foster Child 1302 District Paid Tuition Parent Paid Tuition Tuition Waived Homeless

07/2014

Enrollment Checklist

Proof of Residency RESIDENT FAMILIES Any family that claims residency in the school district must upon enrollment in the school district provide proof of residency. Proof of residency shall be one (1) of the following: Property tax form Deed Lease agreement Letter on apartment complex or mobile home park letterhead signed by the landlord Or two (2) of the following: Utility bill(s) Auto registration Bank statement Auto insurance Unemployment/employment check

THE SCHOOL DISTRICT RESERVES THE RIGHT TO INVESTIGATE ANY OR ALL CLAIMS OF RESIDENCY AND TAKE LEGAL ACTION AGAINST ANY PERSON OR PARTY FOUND TO BE SUPPLYING FALSE INFORMATION TO THE SCHOOL DISTRICT.

FOSTER CARE STUDENTS AND INMATES OF INSTITUTIONS – Send the Original to the Superintendent’s

Office – Keep a copy on file in your office. Any student being enrolled in the Wilmington Area School District as a “Foster Care Student” or an “Inmate of an Institution” shall be considered enrolled only after completion, in person, by a representative of the agency making the placement of “Section 1305/1306 Application.” Examples of “Foster Care Students” would be students placed by the Bair Foundation, Lawrence County Children and Youth, etc. An example of an “Inmate of an Institution” would be George Junior Republic Halfway House Resident. “Foster Care Students” are covered by Section 1305 of the School Code and “Inmates of Institutions” are covered by Section 1306 of the School Code.

AFFIDAVIT STUDENTS AND FOREIGN EXCHANGE STUDENTS– Send the Original to the Superintendent’s

Office – Keep a copy on file in your office. Any student being enrolled in the Wilmington Area School District as an “Affidavit Student” or as a “Foreign Exchange Student” shall be considered enrolled only after completion of a “Section 1302 Affidavit,” signed and notarized. Examples of “Affidavit Students” would be a relative taking in another relative due to family problems. An example of a “Foreign Exchange Student” would be a student attending school through an AFS, Rotary, Etc. program.

IMMUNIZATION RECORDS

SCHOOL RECORDS

HAS THIS STUDENT EVER BEEN ENROLLED IN THE WILMINGTON AREA SCHOOL DISTRICT?

Yes No

HAS THIS STUDENT EVER RECEIVED ANY OF THE FOLLOWING SPECIAL SERVICES:

Educational Speech Vision Hearing Title I (Reading/Math)

Wilmington Area School District 300 Wood Street

New Wilmington, PA 16142

Telephone: (724) 656-8866

FAX: (724) 946-8982

www.wasd.school

Home Language Survey*

The Office of Civil Rights (OCR) requires that school districts/charter schools/full day AVTS identify limited English proficient (LEP) students in order to provide appropriate language instructional programs for them. Pennsylvania has selected the Home Language Survey as the method for the identification.

Date: School: Wilmington Area Elem. School Wilmington Area Middle School

Wilmington Area High School Other Student’s Name: Grade: 1. What is/was the student’s first Language?:

2. Does the student speak a language(s) other than English? Yes No

(Do not include languages learned in school.)

If yes, specify the language(s):

3. What language(s) is/are spoken in your home?

4. Has the student attended any United States school in any 3 years during his/her lifetime?

Yes No

If yes, complete the following:

Name of School State Dates Attended

Person completing this form (if other than parent/guardian): Parent/Guardian Signature: *The school district/charter school/full day AVTS has the responsibility under the federal law to serve students who are limited English proficient and need English instructional services. Given this responsibility, the school district/charter school/full day AVTS has the right to ask for the information it needs to identify English Language Learners (ELLs). As part of the responsibility to locate and identify ELLs, the school district/charter school/full day AVTS may conduct screenings or ask for related information about students who are already enrolled in the school as well as from students who enroll in the school district/charter school/full day AVTS in the future.

Wilmington Area School District 300 Wood Street

New Wilmington, PA 16142

Telephone: (724) 656-8866

FAX: (724) 946-8982

www.wasd.school

Registration Statement

(Please print)

Student’s Name: D.O.B.: As required by Act 26 of 1995, Sections 1304-A, it is required that prior to admission to any school entity, the parent, guardian or other person having control or charge of a student shall, upon registration, provide a sworn statement or affirmation stating whether the pupil was previously suspended or expelled from any public or private school of this Commonwealth or any other state for an act or offense involving weapons, alcohol or drugs, or for the willful infliction of injury to another person or for any act of violence committed on school property. Any willful false statement made under this section shall be a misdemeanor of the Third Degree. TO FULFILL THE REQUIREMENTS OF THE LAW YOU ARE REQUIRED TO COMPLETE ONE OF THE TWO STATEMENTS BELOW. I hereby swear or affirm, under penalty of law that the above named student has not been previously suspended or expelled from any public or private school of the Commonwealth or any other state for an act or offense involving weapons, alcohol or drugs, or for the willful infliction of injury to another person or for any act of violence committed on school property.

Parent/Guardian Signature: Date: Print Parent/Guardian Name: I hereby swear or affirm, under penalty of law that the above named student has been previously suspended or expelled from the School District for an act or offense involving weapons, alcohol or drugs, or for the willful infliction of injury to another person or for any act of violence committed on school property.

Parent/Guardian Signature: Date: Print Parent/Guardian Name:

Date Records Sent For:___________ Requested by:__________ Date Records Rec’d___________

Wilmington Area School District 300 Wood Street

New Wilmington, PA 16142

Telephone: (724) 656-8866

FAX: (724) 946-8982

www.wasd.school

Request for Student Records

Please use this form to request records from other schools and facilities.

(Please print)

Last Name: First Name:

Date of Birth: Sex: Male Female Grade:

Name of Last School Attended:

School Address:

School Phone: FAX:

PA Secure ID Discipline Records

Permanent School Records Special Education Records (Evaluation

Reports and Individual Education Plans)

Health Records Standardized Test Data

Cumulative Records Other:

Wilmington Area School District Wilmington Area Elementary School

Attention: Mrs. Carolyn Huff Wilmington Area Middle School

300 Wood Street Wilmington Area High School

New Wilmington, PA 16142 Other

(724) 656-8866 x 6000

Signature of Parent/Guardian: Date:

Telephone #: Cell #:

Information Requested

Student

Record Request

Send Records To

Authorization to Release Student Records

WILMINGTON AREA SCHOOL DISTRICT

Student Residency Questionnaire

Dear Parent or Guardian, The McKinney-Vento Act, as amended by the No Child Left Behind Act of 2001, defines homelessness and outlines the rights or homeless students. Your responses to these questions will help staff determine what residency documents are necessary for enrollment of your child/children. Thank you for your cooperation. Student name: Date of Birth: Person completing form: Relationship to child: In what type of setting is the student living now?

Check one box below either in Section A or Section B: SECTION A SECTION B

In an emergency or transitional shelter

Sharing the housing of other persons due to loss of housing,

economic hardship, or similar reason

In a motel, hotel, campsites, or cars due to a lack of

alternative adequate accommodations

In a car, park, public spaces, abandoned building,

substandard housing, bus or train stations, or similar settings

Other places not designed for, or ordinarily used as, a

regular sleeping accommodations for human beings

If you checked any box in Section A, continue completing the

information below.

None of the choices in Section A apply.

If you checked this section, you do not need to complete the remainder of this form. Submit the form to school personnel now.

Contact number for person completing the form: ( )

Address where student is now living:

The student lives with: (Check all that apply)

Parent(s) or legal guardian Relative, friend(s), or other adult(s)

Alone Other:

Over

School student attended last:

Address of school:

Telephone number of school:( )

Contact person at school (if known):

Does the student have an IEP or a Chapter 15/504 agreement?

No

Yes, please explain:

The staff person who is helping you register will contact the homelessness coordinator to review

the information provided. If homelessness is verified, additional information will be needed to

complete enrollment. The homelessness coordinator will contact you by the end of the next

school day (or sooner) to share the determination regarding homeless status, to gather

additional information and to discuss the plans for placement.

Signature of Parent/Legal guardian:

Date:

FOR OFFICE USE ONLY

NOTE TO STAFF: All forms with a checked box in Section A are to be faxed immediately to the Homeless Liaison to eliminate any delay.

Name of person contacting parent

Date parent was contacted

Determination of homeless status

Date homeless student was enrolled

Additional information

Signature Date

Transportation Information This information will be given to the bus contractor and your child’s bus driver.

Date Entered

Student’s Last Name First Name

Grade Building D.O.B. Sex

Street Address

City State Zip

Telephone - Home Work

Parent or Guardian

Please list any concerns or medical conditions (allergies, bee stings, asthma, seizures, etc.) that the driver should

be aware of:

Style of your house: One Story Two Story Mobile Home Other

Brick Siding Stone Other

Color of your house:

Please give the location of your house from either direction: (such as, fourth house on the left from Route 208 or

second on the right from Marr Rd.):

Additional Information:

Parent/Guardian Signature Date

If your child is to be picked up or dropped off at a location other than your home address, you must complete an Alternate Bus Stop Request Form. Please contact Melda Irwin, Superintendent’s Secretary at (724) 656-8866 ext. 6100 to request a form.

PLEASE PRINT

WILMINGTON AREA SCHOOL DISTRICT Health Emergency Information

Name M F Grade/Teacher

(Last) (First) (Middle) Sex

Telephone Date of Birth

Custody Papers On File – Date

Father’s Information Mother’s Information Mrs. Ms. Miss

Name Name

Last First M.I. Last First M.I.

Address Address

City City

State Zip State Zip

Home Telephone Home Telephone

Cellular Telephone Cellular Telephone

Father’s E-mail Mother’s E-mail

Employer Employer

Employer’s Address Employer’s Address

Work Telephone Work Telephone

Living with: Father Mother Both Other

Step Parent:

When there is an emergency we always try to contact the parent first. However, please list names, addresses and phone

numbers of two relatives, friends or neighbors we might call in case we cannot contact the parent. Indicate their relationship to

the student.

1. Emergency Contact Person 2. Emergency Contact Person

Relationship Relationship

Name Name

Last First M.I. Last First M.I.

Address Address

City City

State Zip State Zip

Home Telephone Home Telephone

Cellular Telephone Cellular Telephone

Family Physician Physician’s Telephone

Family Dentist Dentist’s Telephone

Do you have a hospital preference: Yes No If yes, where?

Please list other children in family:

Name Birthdate Grade Name Birthdate Grade

Please Check off the medications your child CANNOT receive in school. Permission to give:

Benadryl (allergic reactions) Acetaminophen (Tylenol) Ibuprofen Mylanta/Tums

Antibiotic Ointment (bacitracin) Cough Drops Orajel

I voluntarily consent to emergency treatment, first aid, and screening examinations as may be deemed necessary by the school

physician, nurse, and state mandates. Please check one: Yes No

When unable to contact parent or personal physician, I hereby voluntarily consent to the school physician to authorize treatment

needed at a local hospital, until the parent or personal physician can be reached.

Please check one: Yes No

Do you want this student to receive Fluoride Tablets (grades K-4). Please check one Yes No

(New Wilmington Boro, Volant Boro, Aqua Water Customers in Village of Pulaski, and Shenango Valley Water contain Fluoride).

If no, does your child receive fluoride at home in any of the following: Vitamins Water Other None at all

(See Page 2) Revised 9-16

Parent/Guardian Signature Date (Over)

Wilmington Area School District

Health Inventory

Grade Teacher List medications taken at home:

Student Health Does your child have any problems, which may affect his/her learning in school, cause any concern and/or may be

important for the school staff to know? Please check “yes” or “no” for each of the following health areas:

Yes No

Childhood diseases (e.g. Chicken Pox, Measles, Mumps, etc.)

General Health (e.g. fatigue, low energy level, poor sleep habits,

frequent illness, poor posture)

Specific physical condition/illness past or present (e.g. cerebral palsy,

Seizure disorder, back abnormality, sickle cell anemia, diabetes, heart problem,

Asthma, etc.)

ADD/ADHD

Allergy (e.g. insect stings, foods, drug, environmental) and symptoms

Vision/Eye (e.g. contact lens, glasses, uncorrectable condition, surgery)

Hearing/Ear (e.g. frequent infections, draining ear, hearing aids)

Speech (e.g. delay, stammer, hard to understand)

Development (e.g. slow in walking, speaking, or growing, etc.)

Nutrition (e.g. over or under weight, poor eating habits, anemic)

Alcohol, tobacco, or drug use

Behavior/personal relationships (e.g. very active, easily upset,

needs to be center of attention, loner, shy, has difficulty making friends)

Other (e.g. recent family crisis, job after school, time consuming hobby)

If female: Menstrual (e.g. pain, irregularity, late or early onset)

Remarks: Please explain any “yes” answers or any comments that would be of importance for school personnel to know.

Allergies

If you would like to discuss your child’s health with school personnel, please check title:

Nurse assigned to school Teacher Counselor Principal

If your child has any special medical problems, conditions or any restriction on physical activities, please explain.

I understand that unless otherwise notified, the school nurse will share this information on a confidential basis with

administrators, professional personnel, and support staff members having direct contact with your child to ensure that

his/her health and safety is protected.

Parent/Guardian Signature Date

Anna Daugherty, CSN Elementary School Nurse (ext. 3030) Sarah Vincent, CSN MS/HS School Nurse (ext. 1030)

Interval or Update Health History

To be complete by parent/guardian.

Please print. Student Last Name First Date of Birth Grade School: Pulaski Elementary New Wilmington Elementary

Middle School High School Other 1. Has your child been in good health the past year? Yes No

If no, please explain

2. Has your child had any of the following in the past year:

a) illness lasting more than three (3) days Yes No b) severe injuries or accidents Yes No c) fractures or broken bones Yes No d) sprains or strains Yes No e) time in a hospital Yes No f) operations Yes No g) drugs or treatments prescribed by a physician or clinic Yes No

If yes to any of the above, please explain

3. a) Is your child under the care of a physician or clinic now? Yes No

b) Is your child taking any treatments, or medications now? Yes No c) Does your child use an inhaler? Yes No

If yes to any of the above, please explain (list medications)

Please see PAGE 2

4. Does your child have any allergies to: a) medications Yes No b) foods Yes No c) insects Yes No d) bee stings Yes No c) other Yes No If yes to any of the above, please explain Does it require emergency medication? Yes Medication No

5. In the past year, have you noticed that your child has any of the following problems?

a) trouble with eyes or seeing Yes No b) started wearing glasses Yes No c) started wearing contacts Yes No d) trouble with ears or hearing Yes No e) trouble with allergies Yes No f) trouble with asthma or breathing Yes No g) trouble with eating or with weight loss or gain Yes No h) trouble with sleeping Yes No i) trouble keeping up with activities of his/her friends Yes No j) trouble with class work Yes No k) trouble with school Yes No l) trouble with family Yes No m) problems with general development and maturity Yes No

6. a) has your child seen a dentist in the past year Yes No b) describe the state of your child’s teeth: Teeth missing None Some All Teeth decayed (cavities) None Some All Teeth filled None Some All 7. Has your child had any immunizations the past year? Yes No If yes, please explain

8. Has any member of the family developed any serious health problem in the past year? Yes No If yes, please explain

9. Do you think your child is fit to participate in all school sports, athletics and gym class? Yes No 10. Do you have any concerns regarding your child which you would like to discuss with the school nurse? Yes No Parent/Guardian Signature Date

WILMINGTON AREA SCHOOL DISTRICT 300 WOOD STREET

NEW WILMINGTON, PA 16142 (724) 656-8866

WWW.WASD.SCHOOL

PERMISSION TO BE PHOTOGRAPHED

Dear Parents or Guardian, Throughout the school year there may be times when the students are photographed during classroom activities. These pictures may be submitted with classroom articles and published in the local newspapers and/or the district website. Your permission is necessary for us to photograph your child during these times. Please have your child return this signed permission form to their homeroom teacher.

Student’s Name: Grade: _______ Student’s Homeroom Teacher: ____________________________

My child’s photograph MAY BE used as part of news releases and/or publications.

My child’s photograph MAY NOT BE used as part of news release and/or publications.

My child’s photograph MAY BE used as part of the district website.

My child’s photograph MAY NOT BE used as part of the district website. Parent/Guardian Signature: Date: ________

This form applies to pictures taken during regular school activities for the purpose of possible publication. It does not apply to scheduled school pictures, extra-curricular activities where pictures are taken by newspaper photographers, or pictures taken for the yearbook.