Trinity Charter School – New Life www.trinitycharterschools.org 650 Scarbourough Canyon Lake, TX 78133 (830) 964-4390 *fax: (830) 964-4376 2018-19 Enrollment Checklist The following information is needed for each student at the time of enrollment. A student will not be permitted to start school and will not be given a schedule of classes until the required Health-related documentation is received. For students transferring from another Texas public school, a 30-day grace period is allowed. Please return completed forms to the school office. Information Required at Time of Enrollment: Social Security Card (if no social security card, please communicate to Registrar at time of enrollment) Birth Certificate Immunization Record Immunizations must be up-to-date. Documentation must include month, day & year for each vaccine and a physician signature or clinic stamp. Exemptions may be claimed for medical contraindications and reasons of conscience with the proper documentation. See http://www.dshs.state.tx.us/immunize/school for further information. Unofficial Copy of Transcript / or 8 th grade report card for incoming 9 th graders Special Education/504 records if applicable Face Sheet Court Order/Adoption Papers CPS Placement Agreement/LSS Placement Agreement Student Rights/Educational Decision Maker Form Psychological/Common Application Forms to be Completed Prior to Enrollment: TCS Enrollment Form Home Language Survey Support Services Checklist Previous Schools Form TB Skin Test Assessment Certificate of Immunizations (may attach shot record in place of physician’s signature) TCS Health Information Allergy (Anaphylaxis) Emergency Action Plan (if necessary) Must be completed by a physician for any child who has a severe allergy with risk of anaphylaxis. Severe allergies may include foods, insect bites and stings, etc. Forms can be downloaded from the Trinity Charter School website. Medications required for treatment should be brought to the school nurse prior to the first day of school. Required Documents once School Year Has Begun: Withdrawal forms and transcript/report card from previous school For Office Use Only R Date Received ________________
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Trinity Charter School – New Life
www.trinitycharterschools.org
650 Scarbourough Canyon Lake, TX 78133
(830) 964-4390 *fax: (830) 964-4376
2018-19 Enrollment Checklist
The following information is needed for each student at the time of enrollment. A student will not be permitted to
start school and will not be given a schedule of classes until the required Health-related documentation is
received. For students transferring from another Texas public school, a 30-day grace period is allowed. Please return
completed forms to the school office.
Information Required at Time of Enrollment:
Social Security Card (if no social security card, please communicate to Registrar at time of enrollment)
Birth Certificate
Immunization Record Immunizations must be up-to-date. Documentation must include month, day & year for each vaccine and a physician
signature or clinic stamp. Exemptions may be claimed for medical contraindications and reasons of conscience with the proper documentation. See
http://www.dshs.state.tx.us/immunize/school for further information.
Unofficial Copy of Transcript / or 8th
grade report card for incoming 9th
graders
Special Education/504 records if applicable
Face Sheet
Court Order/Adoption Papers
CPS Placement Agreement/LSS Placement Agreement
Student Rights/Educational Decision Maker Form
Psychological/Common Application
Forms to be Completed Prior to Enrollment:
TCS Enrollment Form
Home Language Survey
Support Services Checklist
Previous Schools Form
TB Skin Test Assessment
Certificate of Immunizations (may attach shot record in place of physician’s signature)
TCS Health Information
Allergy (Anaphylaxis) Emergency Action Plan (if necessary) Must be completed by a physician
for any child who has a severe allergy with risk of anaphylaxis. Severe allergies may include foods, insect bites
and stings, etc. Forms can be downloaded from the Trinity Charter School website. Medications required for
treatment should be brought to the school nurse prior to the first day of school.
Required Documents once School Year Has Begun:
Withdrawal forms and transcript/report card from previous school
FoF For Office Use Only
Date R Date Received
_____ ________________
D
TRINITY CHARTER SCHOOL ENROLLMENT FORM Start Date/SY: 18-19 ID:
The information on this form is pertinent to your child’s records. Please fill out as accurately as possible. The presentation of false documents or records
is an offense under Section 37.10 Penal Code. The enrollment of a child under false documents subjects the person to liability for tuition or costs under
Section 21.-31g of this code.
Student’s Legal Name: Grade:
(As listed on Birth Certificate) (Last) (First) (Middle) (Called By)
Sex: Date of Birth: / / Birthplace: Soc. Sec. #:
Student’s Home Address: Home Phone:
Mailing Address (if different):
Is Student Hispanic/Latino? (please circle): YES NO
{A person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture/origin, regardless of race}
Race/Ethnicity (please check all that apply): American Indian / Alaskan Native
Asian
Black / African
American Native Hawaiian / Other Pacific Islander
White / Caucasian
Name of Previous School: Name of Previous School: Last Grade Completed:
Address/City/State/Zip: Phone/Fax:
Legal Guardianship: Parent CPS JPD Other:
Yes No As a representative of the above agency, I wish to attend all student conferences, including 504 meeting,
attendance, discipline, ARDs, etc. as the legal educational representative of this student.
Has a Court Appointed Surrogate Parent Has an Educational Decision Maker* *A court appointed Educational Decision maker is required on cases after 9/2013
PRIMARY LEGAL GUARDIAN FAMILY INFO – who has legal custody regarding the education of the child
Last Name: First: Spouse’s Last Name: First:
Relationship to Child: Relationship to Child:
Address: Address:
Home Ph: Cell Ph: Home Ph: Cell Ph:
Work Ph: Fax #: Work Ph: Fax #:
Preferred Email: Preferred Email:
SECONDARY LEGAL GUARDIAN FAMILY INFO – joint custody and/or who also has educational rights to the child
Last Name: First: Spouse’s Last Name: First:
Relationship to Child: Relationship to Child:
Address: Address:
Home Ph: Cell Ph: Home Ph: Cell Ph:
Work Ph: Fax #: Work Ph: Fax #:
Preferred Email: Preferred Email:
Parents: Have Educational Rights Rights Terminated
Last Name: First: Spouse’s Last Name: First:
Relationship to Child: Relationship to Child:
Address: Address:
Home Ph: Cell Ph: Home Ph: Cell Ph:
Work Ph: Fax #: Work Ph: Fax #:
Preferred Email: Preferred Email:
Educational Decision Maker:
Last Name: First:
Relationship to Child: Court Appointed Educational Decision Maker Court Appointed Surrogate Parent
Address:
Home Ph: Cell Ph:
Work Ph: Fax #:
Preferred Email:
Court Volunteer/CASA/Guardian Ad Litem: Yes No Receives Educational Paper Work
Last Name: First:
Relationship to Child: Court Appointed Volunteer/CASA Guardian Ad Litem
Address:
Home Ph: Cell Ph:
Work Ph: Fax #:
Preferred Email:
Attorney Ad Litem/Attorney: Yes No Receives Educational Paper Work
Last Name: First:
Relationship to Child: Attorney Ad Litem Attorney
Address:
Home Ph: Cell Ph:
Work Ph: Fax #:
Preferred Email:
(Please
Siblings: (Names) Grade/Age TCS Campus, if applicable
I submit that the information given above is true and correct to the best of my knowledge.
Signature of Legal Parent/Guardian Date
Date
TRINITY CHARTER SCHOOL HOME LANGUAGE SURVEY
The information on this form is required by Section 39.023(m) of the Texas Education Code.
Grades K-12 Name of Child:
Nombre del Niño(a)
Campus: Campus: Trinity Charter School – New Life Campus Grade:
Escuela Escuela: Grado:
(1) What language is spoken in your home most of the time?
¿Qué idioma se habla en su hogar la mayoria del tiempo?
(2) What language does your child speak most of the time?
¿Qué idioma habla su niño(a) la mayoria del tiempo?
(3) What language do you (the parent/s) speak most of the time?
¿Oué idioma hablan más tiempo en su familia?
Signature of Parent / Guardian
Firma del Padre/Madre/ o Representante Legal
Date
Fecha
Student History Enrollment Form
(1) Where was your child born?
(2) Has your child ever lived outside the U.S. for two or more consecutive years? (two years in a row)
YES NO If YES, please complete the rest of this form.
If NO, you do not need to continue.
If YES -- Where?
If YES -- When your child lived outside the U.S., did he or she attend school regularly? (Check one:)
My child attended school regularly in all previous grades outside the U.S.
My child missed significant portions of one or more school years.
Please specify below, including years or partial years:
(3) If your child has ever been enrolled in a U.S. school, please answer below:
Where? Year(s) of Enrollment:
Entire School Year or Partial Year? Total Time Enrolled:
(4) Has your child ever participated in an ESL (English as a Second Language) or Bilingual Education Program? (Please
specify):
TEA 8/05
Trinity Charter School - New Student Health Information
Name Sex Grade Birthdate Teacher
In order to provide an optimum environment, it is important that we have an understanding of your child’s
health status. Contact the school nurse is you wish to discuss any health problems in more detail.
Condition Yes No Please explain “Yes” answers
Asthma
Blood Transfusions
Broken Bones
Diabetes
Head Injury
Heart Condition
Rheumatic Fever
Fainting Spells
Seizures
Surgery
Vision or Hearing Problems
Other:
Allergies: *If at risk for ANAPHYLAXIS, Allergy Emergency Action Plan is REQUIRED.
Medication
Food*
Environmental
Is he/she on medication?
Medication (Name & Strength) Dose/Frequency Days Taken Home School
*Is there any reason he/she can’t participate in a full program, including physical education activities?
Yes No If yes, please explain
*Have there been any stressful events in your child’s life that could have an impact on his emotional well being?
Example: death or serious illness in immediate family, major economic changes, abusive behavior, recent divorce or
remarriage?
Yes No If yes, please explain
*Has your child had chicken pox? Yes No If yes, when? (month/year)
*Has your child had any recent immunizations? Yes No If yes, please attach physician documentation.
Date Signature of Parent/Guardian
Please give name, address and phone number of the doctor who last examined your child.
Signature of Registrar: ____________________________________ Date entered into TxEIS:_________________
Due to Registrar within 10 days of LPAC meeting. Maintain form in cumulative folder Developed 070814
Years in US School (Circle one)
0 - First enrolled in U.S. schools in the second semester of the current school year. 4 - Has been enrolled in U.S. schools for all or part of four school years.
1 - First enrolled in U.S. schools in the first semester of the current school year. 5 - Has been enrolled in U.S. schools for all or part of five school years.
2 - Has been enrolled in U.S. schools for all or part of two school years. 6 - Has been enrolled in U.S. schools for all or part of six or more school years.
3 - Has been enrolled in U.S. schools for all or part of three school years.
Bilingual (Circle one) Note: If the student is in an ESL program, leave the Bilingual field blank.
0 - Does not participate in Bilingual Program. 4 - Dual Language Immersion/Two Way.
ESL (Circle one) 0 - Does not participate in ESL Program. 2 - ESL Content Based. 3 - ESL Pull Out.
LEP Code (Circle one) 0 - Not LEP 1 – LEP
F - Exited from LEP - Monitored 1 (M1) - The student has met the exit criteria for the bilingual/ESL program, is no longer classified as LEP in PEIMS, is in his first year of monitoring, and is not eligible for funding due to the fact that he is not LEP.
S - Exited from LEP - Monitored 2 (M2) - The student has met the exit criteria for the bilingual/ESL program, is no longer classified as LEP in PEIMS, is in his second
year of monitoring, and is not eligible for funding due to the fact that he is not LEP.
Parental Permission Code (Circle One)
3 - Parent/Guardian requested BIL. (non-LEP student) 7 - Parent/Guardian did not respond. 8 - Parent/Guardian was not contacted.
A - Parent/Guardian denied BIL; approved ESL. B - Parent/Guardian approved ESL – Not deny BIL. (PK-8) C - Parent/Guardian denied placement in language program.
D - Parent/Guardian approved BIL placement. E - Parent/Guardian approved BIL not avail. appr. ESL. F - Parent/Guardian approved LPAC
plan. (9-12)
G - Parent/Guardian approved BIL/ESL. H - Requested Placement of non-LEP student in ESL. J - Approved ESL alternative