Page 1 of 18 BUFFALO PUBLIC SCHOOLS Central Registration Center Office of Student Placement & Registration Ms. Kelli Daniels, Director 33 Ash Street Buffalo, New York 14204 Phone (716) 816-3717 Fax (716) 816-3993 Email: [email protected]Dear Parent/Guardian: On behalf of the Board of Education, the Superintendent, staff, and myself, it is with great enthusiasm that I welcome you to Buffalo Public Schools for the 2020 -2021 school year! The enrollment process typically would start with a visit to the Central Registration Center (CRC). During this time of COVID-19, CRC is closed, however, we are still here for you. The following instructions explain the 4 steps necessary to enroll your child in the Buffalo Public School District: Step 1: Complete the following 2020-2021 Registration/Application Packet. Step 2: Photocopy all required registration documents - please refer to page 4 of the registration packet: Child’s Proof of Birth Two Proofs of Address Parent/Guardian Photo Identification Immunization Record(s) (if available) Health Physical Examination (if available) Custody Document(s) (if applicable) Current Report Card and/or Final Transcript Step 3: Bring the Registration/Application Packet & all required documentation in a folder/envelope to the Central Registration Center, 33 Ash Street, Buffalo, NY 14204 (Spruce Street entrance). Packets can be dropped off Monday – Friday from 8:00 a.m. – 3:00 p.m. Please note: If you have multiple children, each child needs a separate Registration/Application Packet. Please place all required documents in the same envelope/folder. Step 4: Upon arrival, place the folder/envelope with the Registration/Application Packet & all required documentation in the registration drop box at the door located at the entrance of the building (incomplete packets or missing documentation will result in processing delays). For safety precautions, please ensure you are wearing a mask. Once you have submitted your documents, you will be required to immediately leave the premises so that the next family can be serviced. You will not be allowed to congregate on the premises, as we must adhere to the NYS Social Distancing Requirements. If you have any questions or concerns regarding the enrollment process, please call 816-3717 or email: [email protected]. We look forward to working with you and your family! *Students in temporary housing, as defined by McKinney-Vento, are not required to submit registration documents in order to enroll. For assistance with registration and eligibility guidelines or if you have questions, please contact the McKinney-Vento Department at [email protected]or 716-816-3717, Ext. 3. Sincerely, Ms. Kelli A. Daniels Director of Student Placement & Registration
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On behalf of the Board of Education, the Superintendent, staff, and myself, it is with great enthusiasm that I welcome you
to Buffalo Public Schools for the 2020 -2021 school year! The enrollment process typically would start with a visit to the
Central Registration Center (CRC). During this time of COVID-19, CRC is closed, however, we are still here for you.
The following instructions explain the 4 steps necessary to enroll your child in the Buffalo Public School District:
Step 1: Complete the following 2020-2021 Registration/Application Packet.
Step 2: Photocopy all required registration documents - please refer to page 4 of the registration packet:
Child’s Proof of Birth
Two Proofs of Address
Parent/Guardian Photo Identification
Immunization Record(s) (if available)
Health Physical Examination (if available)
Custody Document(s) (if applicable)
Current Report Card and/or Final Transcript
Step 3: Bring the Registration/Application Packet & all required documentation in a folder/envelope to the Central
Registration Center, 33 Ash Street, Buffalo, NY 14204 (Spruce Street entrance). Packets can be dropped off
Monday – Friday from 8:00 a.m. – 3:00 p.m. Please note: If you have multiple children, each child needs a
separate Registration/Application Packet. Please place all required documents in the same
envelope/folder.
Step 4: Upon arrival, place the folder/envelope with the Registration/Application Packet & all required
documentation in the registration drop box at the door located at the entrance of the building (incomplete
packets or missing documentation will result in processing delays). For safety precautions, please ensure you are
wearing a mask. Once you have submitted your documents, you will be required to immediately leave the premises so that
the next family can be serviced. You will not be allowed to congregate on the premises, as we must adhere to the NYS
Social Distancing Requirements.
If you have any questions or concerns regarding the enrollment process, please call 816-3717 or email:
[email protected]. We look forward to working with you and your family!
*Students in temporary housing, as defined by McKinney-Vento, are not required to submit registration documents in order to enroll. For assistance with
registration and eligibility guidelines or if you have questions, please contact the McKinney-Vento Department at [email protected] or
716-816-3717, Ext. 3.
Sincerely,
Ms. Kelli A. Daniels Director of Student Placement & Registration
Documents Required to Complete the Registration Process
Please ensure all REQUIRED documents are attached. If the REQUIRED documents are not enclosed or the registration packet is incomplete, your child’s registration may be delayed.
REQUIRED: One (1) Proof of birth/child’s age: birth certificate, passport, I-94 card, or hospital certificate REQUIRED: One (1) Document that links the child to the parent/guardian: birth certificate, I-94 card with family home page, current copy income tax form filed, or custody papers REQUIRED: One (1) Parent/guardian’s photo identification: Valid Driver License, Non-Driver Identification Card, Valid Learner Permit, Erie County Department of Social Services (ECDSS) Benefit Card, Employee Identification Card, Birth Certificate Card, or Membership Card that has not expired
REQUIRED: TWO (2) proofs of address from the list below to verify the parent/guardian resides in
the City of Buffalo School District: Below there are 9 (nine) categories to choose from - You may only use one (1) proof of address from each category
Valid NYS Driver License, Non-Driver Identification card, or NYS Learner Permit that has not expired
Residential Utility Bill (gas, electric or cable) issued by a utility company (such as National Grid, Spectrum, or National Fuel) within the past 30 days
Official payroll documentation from an employer issued within the last 30 days, such as a pay stub with the home address
Notice of Decision Statement from the Erie County Department of Social Services (within the year of date – not expired - example; ECDSS Budget Sheet with the home address)
Documentation/letter on letterhead from a federal, state, or local government agency including the IRS, the City Housing Authority, or Office of Refugee Resettlement within the past 60 days
Signed residential lease within the last year
Bank Statement (Mortgage, Checking, Savings, or Credit Card) with address within the past 30 days
Valid Vehicle Registration
Valid Voter Registration Card
PREFERRED: Report Card for students entering grades 1 - 8 and transcript for students entering grades 9 – 12 (Student Placement & Registration will request your child’s academic records from their prior school if not included – this may delay processing)
PREFERRED: IEP- Individualized Education Program document for Special Education Students (The Department of Special Education will request your child’s IEP from their prior school if not included- this may delay processing)
PREFERRED: 504/ADA (American Disability Act) (Student Placement & Registration will request the document from your child’s prior school if not included)
OPTIONAL: Up-to-Date Immunization Record (required 14 days after start of school)
OPTIONAL: Latest Physical Examination (required 30 days after start of school)
CUSTODY OR COURT DOCUMENTS IF CHILD DOES NOT RESIDE WITH BIRTH PARENT(S)
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BUFFALO PUBLIC SCHOOL STUDENT ENROLLMENT FORM 2020-2021:
Office Use Only: STUDENT INFORMATION: STUDENT ID#: __________________ MAGNET #:__________ Last Name: __________________________ First Name: _________________ Middle Name: _____________ Date of Birth: ____________________ Gender: Male: _____ Female: _____ Twin: Yes: ____ No: ____
Is the Student Hispanic, Latino or of Spanish Origin? ________Yes, Hispanic
________No, not Hispanic
Select one or more races: ________American Indian or Native American ________Asian ________ Black _______White _______Native Hawaiian or Other Pacific Islander
STUDENT SCHOOL INFORMATION: Has this student ever received ENL or Bilingual services? Yes: _____ No: ______
If yes, indicate service: ___________________
Does the student currently receive Special Education Services? Yes: _____ No: ______
If yes, indicate service: ___________________
Does the student receive 504/ADA (American Disability Act) services? Yes: _____ No: ______ Has your child ever attended a Buffalo Public School? Yes: _______ No: ________ Current Grade Level 2020-2021: _________ Previous School Attended: ____________________________________________________________________ Previous School Address: _____________________________________________________________________ Previous School City/State/Zip: ________________________________________________________________ Previous School Phone Number: ( ) ________________________ Previous School Fax Number: ( ) ________________________ Dates of Attendance at Previous School: ________________________ through ________________________ Has your child ever been suspended/expelled from any former school? Yes: _______ No: _______
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SCHOOL CHOICE SELECTIONS - 2020-2021 School Year: Please indicate school choices for your child based on the schools listed on pages 15 to 18. School Number/Name: __________________________________________ School Program: _____________ School Number/Name: __________________________________________ School Program: _____________ School Number/Name: __________________________________________ School Program: _____________ School Number/Name: __________________________________________ School Program: _____________ School Number/Name: __________________________________________ School Program: _____________ STUDENT/PARENT/SIBLING HOUSEHOLD INFORMATION:
HOUSEHOLD INFORMATION: (POST OFFICE BOX IS NOT AN ACCEPTABLE ADDRESS) Household Address: ______________________________________________________________________
PARENT/GUARDIAN: Parent/Guardian who resides at the same address as student. Parent/Guardian Name: _______________________________ Male: ____ Female: _____ Relationship to child: ____________
Please indicate if the Parent/Guardian is a Migrant Worker: Yes: __________ No: __________ Parent/Guardian Name: _______________________________ Male: ____ Female: _____ Relationship to child: ____________
Please indicate if the Parent/Guardian is a Migrant Worker: Yes: __________ No: _________
ADDITIONAL GUARDIAN INFORMATION: PARENT/GUARDIAN: (ONLY complete if other parent/guardian does not reside with student) Parent/Guardian Name: _______________________________ Male: ____ Female: _____ Relationship to child: ____________ Address: ________________________________________________________________________________
City: ___________________ State: _______ Zip: ___________ Primary Phone Number: ( ) _______________________ Email: ____________________________________________________________________________________________________ Please indicate if the Parent/Guardian is a Migrant Worker: Yes: ____________ No: ____________
Page 7 of 18
SIBLING/CO-APPLICANT INFORMATION: Please list all information below for all brothers and/or sisters ATTENDING SCHOOL and living in the same household as the student enrolling in school.
Co-Applicant (Co-App): is defined as a sister/brother of child that is also applying to attend a BPS. Current BPS: is defined as a sister/brother of child that is currently enrolled and attending a Buffalo Public School (BPS). Name: ________________________________________ DOB: ______________ Grade for 2020-2021 _________Gender: _______ Indicate: Co-App_____ Current BPS______ Office Use Only: Magnet#______________ Name: ________________________________________ DOB: ______________ Grade for 2020-2021 _________Gender: _______ Indicate: Co-App_____ Current BPS______ Office Use Only: Magnet#______________ Name: ________________________________________ DOB: ______________ Grade for 2020-2021 _________Gender: _______ Indicate: Co-App_____ Current BPS______ Office Use Only: Magnet#______________ Name: ________________________________________ DOB: ______________ Grade for 2020-2021 _________Gender: _______ Indicate: Co-App_____ Current BPS______ Office Use Only: Magnet#______________ Name: ________________________________________ DOB: ______________ Grade for 2020-2021 _________Gender: _______ Indicate: Co-App_____ Current BPS______ Office Use Only: Magnet#______________
Emergency Contact Information: Please list person(s) OTHER THAN PARENTS we may contact if the parent(s)
or guardian(s) cannot be reached. These individuals have permission to make decisions concerning your child in the event of an emergency and to pick your child up from school.
Phone Number: ( )________________________ Relationship to child: ______________________________
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Information of Rights of Parent from the Family Education Rights and Privacy Act (FERPA) An educational agency or institution shall give full rights under the Act to either parent, unless the agency or institution has been provided with evidence that there is a court order, state statute, or legally binding documents relating to such matters as divorce, separation or custody that specifically revokes these rights. (Authority: 20 U.S.C. 1232g) Please check the current custody/guardianship arrangement:
□ Parent/Guardians are together residing at the same residence.
□ Single parent (father and mother ARE listed on the birth certificate)
□ Single parent (i.e. father IS NOT listed on the birth certificate)
□ Parent/Guardians divorced/separated – Joint Custody (legal documentation must be provided if there is a dispute over
primary residential address)
□ Parent/Guardian divorced/separated – Sole Custody (legal documentation must be provided)
□ Parents have never been married and no legal custody papers
□ Custody/Guardianship is transferred by the courts (legal documentation must be provided)
□ Restricted pickup (legal documentation must be provided)
□ Student is emancipated (legal documentation must be provided)
Please check all that apply:
□ I have disclosed my current custody/guardianship arrangement
□ I have attached a copy of the legal current court documents that describe custody arrangements.
□ No legal documents that describe custody arrangements exist
□ I understand that it is my responsibility to update my child’s school of changes in custody
Please note: Central Registration Office is responsible for registration, not determining which parent or guardian may check a child in/out of school. If custodial or guardianship issues exist when you register your child in the Buffalo Public School District, it is your responsibility to provide custodial documentation to the Student Placement & Registration Office and a copy will scanned into the BPS Student Information System. In addition: If a change of custody is made after a student is enrolled and attending a Buffalo Public School, you are responsible to provide the documentation directly to the school. You do not bring it to Central Registration.
Please keep your child’s school informed of any changes in custodial arrangements
SIGNATURE OF PARENT/GUARDIAN: X_________________________________________ DATE: X_______________________________
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STATE EDUCATION DEPARTMENT/ THE UNIVERSITY OF THE STATE OF NEW YORK / ALBANY, NY 12234 Office of P-12
Elisa Alvarez, Associate Commissioner Office of Bilingual Education and World Languages
55 Hanson Place, Room 594 89 Washington Avenue, Room 528EB Brooklyn, New York 11217 Albany, New York 12234 Tel: (718) 722-2445 / Fax: (718) 722-2459 Tel: (518) 474-8775 / Fax: (518) 474-7948
Home Language Questionnaire (HLQ) Dear Parent or Guardian: In order to provide your child with the best possible education, we need to determine how well he or she understands, speaks, reads and writes in English, as well as prior school and personal history. Please complete the sections below entitled Language Background and Educational History. Your assistance in answering these Questions is greatly appreciated. Thank you.
Please write clearly when completing this section. STUDENT NAME:
First Middle Last
DATE OF BIRTH: GENDER:
MALE FEMALE
Month Day Year
PARENT/PERSON IN PARENTAL RELATION INFO:
LAST NAME FIRST NAME RELATION TO STUDENT
HOME LANGUAGE CODE
Language Background (Please check all that apply)
1. What language’s is(are) spoken in the student’s home or resident? □ English □ Other_________________________________
___ Specify
2. What was the first language your child learned? □ English □ Other____________________________________
Specify
3. What is the Home Language of each parent/guardian? □ Mother _______________ specify
Signature of Parent or of Person in Parental Relation DATE
Relationship to student: Mother Father Other: _____________________________________________
OFFICIAL ENTRY ONLY – NAME/POSITION OF PERSONNEL ADMINISTERING HLQ
NAME: __________________________________________________________ POSITION: ___________________________________________________________ IF AN INTERPRETOR IS PROVIDED, LIST NAME, POSITION AND CREDENTIALS:
NAME/POSITION OF QUALIFIED PERSONNEL REVIEWING HLQ AND CONDUCTING INDIVIDUAL INTERVIEW
ORAL INTERVIEW NECESSARY: No Yes **DATE OF INDIVIDUAL INTERVIEW: _________________________________ MO DAY YR
OUTCOME OF ADMINISTER NYSITELL
INDIVIDUAL ENGLISH PROFICIENT
INTERVIEW REFER TO LANGUAGE PROFICIENCY TEAM
NAME/POSITION OF QUALIFIED PERSONNEL ADMINISTERING NYSITELL
NAME: __________________________________________________________ POSITION: ___________________________________________________________ DATE OF NYSITELL PROFICIENCY LEVEL
ADMINISTRATION: ACHIEVED ON ENTERING EMERGING TRANSITIONING EXPANDING COMMANDING ____________________________ NYSITELL: MO DAY YR
FOR STUDENTS WITH DISABILITIES, LIST ACCOMODATIONS, IF ANY, ADMINISTERED IN ACCORDANCE WITH IEP PURSUANT TO CSE RECOMMENDATION:
2 ENGLISH
Educational History
8. Indicate the total number of years that your child has been enrolled in school _________________________
9. Do you think your child may have any difficulties or conditions that affect his or her ability to understand, speak, read or write in English or any
How severe do you think these difficulties are? Minor Somewhat Severe Severe
10a. Has your child ever been referred for a special education evaluation in the past? No Yes* Please complete 10b below.
10b. *If referred for an evaluation, has your child ever received any special education services in the past?
No Yes – Type of services received: __________________________________________________________________________
Age at which services received (Please check all that apply):
Birth to 3 years (Early intervention) 3 to 5 years (Special Education) 6 years or older (Special Education)
10c. Does your child have an Individualized Education Program (IEP)? No Yes 11. Is there anything else you think is important for the school to know about your child? (e.g., special talents, health concerns, etc.)
_________________________________________________________________________________________________________________________ 12. In what language(s) would you like to receive information from the school?_________________________________________________
Page 11 of 18
Buffalo Public Schools - Department of Social and Emotional Wellness Support HEALTH HISTORY
CHILD’S NAME _____________________________________________D.O.B. ________________________________________
PLEASE ANSWER THE FOLLOWING QUESTIONS AND EXPLAIN YES ANSWERS: Is your child under medical care now? __________________________________________________________________________ Is student taking any medication? ___________________________during regular School Hours? ___________________________ Name __________________________________________________ Dosage______________________ Frequency _____________ Allergies: __________________________________________________________________________________________________
Does your child have Asthma? Yes No
Has your child ever had episodes of wheezing, shortness of breath or frequent day or night coughing? Yes No
Have you heard your child wheeze or cough after active playing? Yes No Is the student able to participate in gym classes? ___________________________________________________________________