New Student Enrollment Form Part 2 of 3

Prior to filling out this form, please ensure you have filled out the pre-registration form on EVSC Parent Access, found here


New Student Enrollment Part 2 of 3

Student Full/Legal Name: 

Birthdate:   

Do you currently own or rent your home? 


Household 1 (Parents/Guardians living with student. i.e. mom & dad, mom & stepdad, etc.)

Relationship to Student: 

Address: 

Parent/Guardian 1: 

Parent/Guardian 1 Cell Phone Number: 

Parent/Guardian 1 Workplace: 

Parent/Guardian 1 Work Phone Number : 

Parent/Guardian 1 Email Address: 

 

Parent/Guardian 2 Name: 

Parent/Guardian 2 Cell Phone Number: 

Parent/Guardian 2 Workplace: 

Parent/Guardian 2 Work Phone Number: 

Parent/Guardian 2 Email Address: 

 

Household 2: Other Parents/Guardians NOT Living with Student, if applicable

Relationship to Student: 

Address: 

Parent/Guardian 1: 

Parent/Guardian 1 Cell Phone Number: 

Parent/Guardian 1 Workplace: 

Parent/Guardian 1 Work Phone Number: 

Parent/Guardian 1 Email Address: 

 

Parent/Guardian 2: 

Parent/Guardian 2 Cell Phone Number: 

Parent/Guardian 2 Workplace: 

Parent/Guardian 2 Work Phone Number: 

Parent/Guardian 2 Email Address: 


Home Language Survey

The Civil Rights Act of 1964, Title VI, Language Minority Compliance Procedures, requires school districts and charter schools to determine the language(s) spoken in each student’s home in order to identify their specific language needs. This information is essential in order for schools to provide meaningful instruction for all students as outlined Plyler v. Doe, 457 U.S. 202 (1982).

 

The purpose of this survey is to determine the primary or home language of the student. The HLS must be given to all students enrolled in the school district / charter school. The HLS is administered one time, upon initial enrollment, and remains in the student's cumulative file. If original HLS is received, then the original version must be filed with student record.

 

Please note that the answers to the survey below are student-specific. If a language other than English is recorded for ANY of the survey questions below, the W-APT will be administered to determine whether or not the student will qualify for additional English language development support.

 

1. What is the native language of the student? 

   If Other, please list: 

2. What language(s) is spoken most often by the student? 

To select multiple languages, use Control key or Command key on Mac. 

    If Other, please list: 

3. What language(s) is spoken by the student at home? 

To select multiple languages, use Control key or Command key on Mac. 

  If Other, please list: 


Ethnicity

1. Is your child Hispanic or Latino? (Please check only one.)  


Additional Enrollment Questions

1. Is there anyone, by court order, who is not allowed to pick up your student?

If so, please list.(School must be provided legal documents in order to enforce if a person listed is a parent.)

2. How will your student normally arrive at school? 

3. How will your student normally go home? 

4. Is this student's parent(s) a current duty member of any branch of the armed forces? 

5. Within the last 3 years, has your child(ren) moved from one school district to another within the United States, with a parent, relative or guardian, so that person could look for seasonal or temporary work in agriculture? 

6. If enrolling in fourth grade or higher from another Indiana school, did your student pass IREAD? 

7. If enrolling in fourth grade or higher from another Indiana school, list the school and city where your student took the IREAD test: 

   School:         City: 

8. If enrolling in PreK or Kindergarten: Is your child currently attending or has your child attended one of the preschool programs listed below? If yes, please indicate which one your child most recently attended. 

9. If born outside U.S.:

     What date did your student enroll in a U.S. School: 

      Name of School: 

10. Does your student have or receive: 

11. Is your student currently under expulsion/suspension from another school? 

12. Is your student interested in enrolling in the EVSC's Virtual Academy (online school) or New Tech Institute (high school)? If so, please check which one.  


Digital Access

Does your student have access to the Internet at home? 

Does your student have access to a device at home? 

If yes, how many devices do you have available at home for your student? (smartphone, laptop, ipad, etc.)  

Select the primary type of Internet service used at your student's home? 

Can your student stream a video on their learning device without interruption? 


Student Health

Does your child have any major health concerns? 

If yes, which one(s)? 

To select multiple conditions use Control key or Command key on Mac. 

   If other, please list: 

Does your student have Allergies? 

  If yes, what kind? 

To select multiple conditions use Control key or Command key on Mac. 

  If Other, please list: 

Does your student take medication? 

Please list any additional health concerns regarding your student: 


By entering your name below, you confirm that the information shared above is true, correct and to the best of your knowledge. 

Parent Signature:       Date: 

 



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