NEW STUDENT REGISTRATION/ENROLLMENT CHECKLIST & PROCEDURE Please help us serve you better by using this checklist as you collect the information and documentation necessary for enrolling your student at Kennewick High School. FORMS INCLUDED IN PACKET Student Records Release Request – Complete the form and sign it. Registration/Enrollment Form - Complete both sides of the form and sign it. Include any court documents relating to guardianship or a parenting plan, if applicable. Verification of Residence – Complete form and sign. Attach address verification document. Student Housing Questionnaire – Complete and sign the form. Student Health History – Complete and sign the form. Certificate of Immunization Status (CIS) – Washington State law requires the use of the official CIS form, which is to be completed and signed by the parent/guardian. Home Language Survey – Complete and sign the form. KHS Student Behavior Expectations – Student will complete and sign the form with their counselor. Kennewick High School Map and Bell Schedule – For your information only. Legal Guardianship Verification Requirements – For your information only. RCW 28A225330 – For your information only. Electronic Policy – For your information only. DOCUMENTS NEEDED At least one address verification document – Current telephone, utility or cable bills; lease or mortgage information. We will make a photo copy of the required documents. Court Documents pertaining to guardianship or parenting plan – Attach to Registration Packet (if applicable). REGISTRATION PROCESS AND PROCEDURE – FOR YOUR INFORMATION 1. Pick up New Student Registration/Enrollment Packet from the Kennewick High School Main Office. 2. Complete and sign all forms and return them to the Counseling Office. 3. Counseling Office will request records from the previous school. You can help expedite this process by bringing an unofficial transcript, withdraw grades, test scores and immunizations with you when you return the packet. 4. When records are received, we will schedule a meeting with an administrator – parents and students are REQUIRED to be present at this meeting. 5. A Measure of Academic Progress Test (MAP Test) will be scheduled after the meeting to assist in placement of your student to the appropriate classes. 6. Last, an appointment with your student’s counselor will be made to create a schedule of courses. 7. Information & Application for Free or Reduced Price Meals is available upon request. K ENNEWICK H IGH S CHOOL 500 South Dayton Kennewick, WA 99336-5674 (509) 222-7100 Fax (509)222-7101 LIONS -s>*
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NEW STUDENT REGISTRATION/ENROLLMENT CHECKLIST & PROCEDURE
Please help us serve you better by using this checklist as you collect the information and documentation necessary for enrolling your student at Kennewick High School.
FORMS INCLUDED IN PACKET
Student Records Release Request – Complete the form and sign it. Registration/Enrollment Form - Complete both sides of the form and sign it. Include any court documents
relating to guardianship or a parenting plan, if applicable. Verification of Residence – Complete form and sign. Attach address verification document. Student Housing Questionnaire – Complete and sign the form. Student Health History – Complete and sign the form. Certificate of Immunization Status (CIS) – Washington State law requires the use of the official CIS form, which is
to be completed and signed by the parent/guardian. Home Language Survey – Complete and sign the form. KHS Student Behavior Expectations – Student will complete and sign the form with their counselor. Kennewick High School Map and Bell Schedule – For your information only. Legal Guardianship Verification Requirements – For your information only. RCW 28A225330 – For your information only. Electronic Policy – For your information only.
DOCUMENTS NEEDED
At least one address verification document – Current telephone, utility or cable bills; lease or mortgage information. We will make a photo copy of the required documents.
Court Documents pertaining to guardianship or parenting plan – Attach to Registration Packet (if applicable). REGISTRATION PROCESS AND PROCEDURE – FOR YOUR INFORMATION
1. Pick up New Student Registration/Enrollment Packet from the Kennewick High School Main Office. 2. Complete and sign all forms and return them to the Counseling Office. 3. Counseling Office will request records from the previous school. You can help expedite this process by bringing
an unofficial transcript, withdraw grades, test scores and immunizations with you when you return the packet. 4. When records are received, we will schedule a meeting with an administrator – parents and students are
REQUIRED to be present at this meeting. 5. A Measure of Academic Progress Test (MAP Test) will be scheduled after the meeting to assist in placement of
your student to the appropriate classes. 6. Last, an appointment with your student’s counselor will be made to create a schedule of courses. 7. Information & Application for Free or Reduced Price Meals is available upon request.
Note: Students residing outside of Kennewick High Schools boundaries may apply
for admissions through a District Transfer Request. All requests will be considered
on an individual basis.
Kennewick School District
1000 W. 4th Ave
Kennewick, WA 99336
Student Housing Questionnaire
Please use one form per student. Return to school registration office within 14 days of receipt. If you require additional
copies, please contact your school.
Name of Student: First Middle Last
Name of School: Grade: Birthdate: Age: Month/Day/Year
Sex: Male Female
The answers to the following questions can help determine the services this student may be eligible to receive under the
McKinney-Vento Act 42 U.S.C. 11435.
1. Is this student’s home address a temporary living arrangement? Yes No
2. Is this a temporary living arrangement due to a loss of housing or economic hardship? Yes No
3. Is this student awaiting foster care placement? Yes No
4. As a student, are you living with someone other than your parent or legal guardian? Yes No
If you answered YES to any of the above questions, please complete the remainder of this form.
If you answered NO to all of the above questions, you may stop here.
Where is this student currently living? (check box)
Temporarily with another family because we cannot afford or find affordable housing.
With an adult that is not a parent or legal guardian, or alone without an adult.
In a hotel/motel.
In a vehicle of any kind, RV park or campground, abandoned building or substandard housing.
In an emergency/transitional shelter.
Other
ADDRESS OF CURRENT RESIDENCE:
(OR)
NAME OF MOTEL/SHELTER OF CURRENT RESIDENCE:
(OR)
NAME OF “GENERAL AREA” OF CURRENT RESIDENCE:
PHONE NUMBER OR CONTACT NUMBER: NAME OF CONTACT:
Print name of parent(s)/legal guardian(s):
(Or unaccompanied youth)
Signature of parent/legal guardian: Date:
(Or unaccompanied youth)
For School Staff Only: Forward questionnaire to Federal Programs, Attn: Homeless Support Coordinator
Distrito Escolar de Kennewick
1000 W. 4th Ave
Kennewick, WA 99336
Estudiante Cuestionario de Vivienda
Por favor llene una forma por cada estudiante. Regrese esta forma a la oficina de la escuela a más tardar 14 días que lo
reciba. Si requiere más copias, por favor póngase en contacte la escuela.
Nombre del estudiante: Primer Segundo Apellido
Nombre de la escuela: Grado: Fecha de nacimiento: Edad: Mes/Día/Año
Género: Hombre Mujer
Las respuestas a estas preguntas podrán ayudar en determinar la elegibilidad de los servicios que el estudiante podría
recibir bajo la ley “McKinney-Vento Act 42 U.S.C. 11435.”
1. ¿Es la dirección del estudiante una vivienda temporal? Sí No
2. ¿Esta vivienda temporal es debido a la pérdida de su hogar o dificultad económica? Sí No
3. ¿Está el estudiante esperando que lo coloquen en un “hogar de crianza” (Foster Home)? Sí No
4. Como estudiante, ¿estás viviendo con otra persona que no sea tu padre/madre o guardián legal? Sí No
Si usted contesto “SI” a cualquier de las preguntas arriba, por favor llene el resto de la forma.
Si usted contesto “NO” a todas las preguntas por favor pare aquí.
¿Dónde vive el estudiante actualmente? (Marque la casilla)
Temporalmente vive con otra familia porque nosotros no podemos pagar o encontrar una vivienda económica
Con un adulto que no es su padre o guardián legal, o solo sin un adulto.
En un hotel/motel.
En un vehículo (cualquier tipo; como un RV), o un área de campamento o un edificio abandonado o vivienda precaria
En un refugio/albergue de emergencia/temporal
Otro
Dirección actual:
(O)
Nombre del Motel/ refugio/albergue:
(O)
Nombre del área general donde vive actualmente:
Número de teléfono: Nombre del contacto:
Nombre de los padres / guardianes:
(O del joven no acompañado)
Firma de los padres / guardián: Fecha:
(O del joven no acompañado)
For School Staff Only: Forward questionnaire to Federal Programs, Attn: Homeless Support Coordinator
STUDENT HEALTH HISTORY
TO BE COMPLETED BY PARENT/GUARDIAN
KSD:Health History form: 1/2015
Name of Student:_______________________________ Date of Birth:___________Grade: _____Sex: Male Female
VISION AND HEARING
No Yes Glasses/Contacts Date of last eye exam:_____________________________________
No Yes Hearing aids Date of last hearing exam:__________________________________
MEDICATION No Yes Medication needed at home (list):_______________________________________________
No Yes *Medication needed at school (list):_______________________________________
*Daily Medications Needed at School – Medication at School form required State law requires written permission from a Health Care Provider and parent before any medication can be given at school. (prescription/over-the-counter). A form is available from the school office.
LIFE THREATENING CONDITIONS -WILL require Health Care Provider order & Individual Health Plan (IHP)
Life Threatening Medical Conditions Washington State law mandates that students with life-threatening health conditions, where the condition would “...put the child in danger of death during the school day”, have 1) medication/treatment orders written by a health care provider that is reviewed by the nurse and signed by the parent 2) an Individual Health Plan (IHP)/nursing plan 3) staff trained in place at school before your child can attend school. Forms are available from the school office.
(*note a SEVERE allergy is one that has been diagnosed by a Health Care Provider and medication has been ordered)
No Yes *Severe Allergic reaction to Nuts/other foods(list):____________EpiPen ordered: ___yes ___no
No Yes *Severe Allergic reaction to Bee Stings EpiPen ordered: ___yes ___no
No Yes *Other Severe Allergies-affecting school. Specify:___________ _ Epipen ordered: ___yes ___no
No Yes Severe Asthma: regularly takes medication for asthma, or has been hospitalized within last 5 years for asthmatic condition
No Yes Diabetes Type 1 Type 2
No Yes Other:___________________________________________________________________________
POTENTIALLY LIFE THREATENING CONDITIONS The school nurse may contact the parent/guardian for further information. Healthcare provider orders, IHP and/or nursing care plan may be needed. No Yes Asthma: takes medication only when needed
No Yes Food aversions/sensitivities_________________________________________________________
No Yes Seizure Disorder Type of Seizures and date of last Seizure__________________________
No Yes Heart Condition: __________________________________________________________________
No Yes Behavioral/Emotional Concerns: _____________________________________________________
No Yes Orthopedic Condition: ______________________________________________________________
No Yes Other Health Concerns: _____________________________________________________________
Does your child have any other condition that would affect his/her classroom performance or P.E. activities? No Yes If yes, explain:_____________________________________________________________________
This information is considered confidential. It will be shared with school staff as needed, including the school health alert, during the time your child is enrolled in Kennewick School District in order to ensure the health and safety of your child, unless otherwise requested by you in writing.
Nombre del estudiante: _________________________________ FDN: ___________ Grado: ____ Hombre Mujer
VISION Y AUDICION No Si Lentes/Lentes de contacto, fecha del último examen: __________________________ No Si Aparatos de Audición, fecha del último examen: __________________________
MEDICAMENTO No Si Medicamento necesario el hogar (especifique):___________________________________________
No Si *Medicamento necesario en la escuela (especifique): __________________________________
LAS CONDICIONES QUE PONENE EN PELIGRO LA VIDA – Requieren ordenes de parte de un médico y un plan
de salud individualizado (IHP)
(* Una alergia severa significa que ha sido diagnosticado por un médico y el medicamento ha sido ordenado)
No Sí * Reacción alérgica severa a cualquier clase de nuez / alimento: __________ EpiPen ordenado: __ si __ no No Sí * Reacción alérgica severa a la picadura de abejas: EpiPen ordenado: __ si __ no No Sí * Otras alergias severas que afecten la asistencia a clases. Especifique: ______ EpiPen ordenado: __ si __ no No Si Asma severa: Toma medicamento regularmente, ha sido hospitalizado en los últimos 5 años por una
condicione asmática No Sí Diabetes Tipo 1 Tipo 2
No Sí Otros:________________________________________________________________________________
CONDICIONES POTENCIALES QUE PONEN EN PELIGRO LA VIDA - La enfermera de la escuela podrá contactar a los padres/ guardián para más información. Se podría necesitar órdenes del médico, IHP y/o un plan de parte de la enfermera. No Si Asma: Toma medicamento solo cuando es necesario No Sí Convulsiones: Tipo de convulsión y fecha de la última convulsión: ___________________________ No Sí Problemas con el corazón: ________________________________________________________________ No Sí Problemas de Comportamiento/Emocionales: ________________________________________________ No Sí Problemas ortopédicos: __________________________________________________________________ No Sí Otros problemas de salud: ________________________________________________________________
¿Hay alguna otra condición que afectaría el desempeño de su estudiante en el salón de clases o en educación física? No Si Explique si marco que sí: __________________________________________________________________
Esta información se considera confidencial. Será compartida con el personal de la escuela, según sea necesario durante el tiempo que su hijo esté inscrito en el Distrito Escolar de Kennewick, para asegurar la seguridad y la salud de su hijo, a menos que usted solicite por escrito lo contrario.
Firma de los padres/guardián ________________________________________ Fecha: _____________________
*Medicamento diario en la escuela – Se requiere la forma de medicamento en la escuela La ley del Estado requiere que la escuela reciba el permiso por escrito del doctor antes de que se le pueda administrar cualquier tipo de medicamento (con / sin receta) al estudiante en la escuela. La forma está disponible en la oficina de la escuela.
Condiciones médicas que ponen en peligro la vida. La ley del Estado de Washington obliga que los
estudiantes con condiciones médicas que ponen en peligro la vida, cuya condición podría “…poner al niño en peligro de muerte durante el día escolar”, deben tener: 1) ordenes escritas por un doctor, que hayan sido revisadas por la enfermera de la escuela y firmadas por los padres, acerca de los medicamentos y tratamientos. 2) un plan de salud individualizado (IHP) / plan de la enfermera. 3) el personal escolar debe ser entrenado antes que su estudiante asista a la escuela. Las formas están disponibles en la oficina principal de la escuela.
Packet given to Parent
Date ___________
Initial___________
Parents of Children Graduating the year 2017 or 2018,
The vaccine requirements for school attendance will be changing for the 2016/2017 school year.
The new requirements will be two varicella (chicken pox) vaccines for grades K-12. If your child
has not had 2 varicella shots or doctor documentation of chicken pox in the school records, it
will be required at school.
If your child gets their Varicella vaccines, please provide a copy of your child’s vaccine record to
school. Getting a jump start on this would help with this transition.
Thank you,
High School Nurses
Mary Jo Wilkins RN Pam Kirkpatrick RN Jeanne Bakker RN Kathy Perez RN
Ron Williamson, Assistant Superintendent, Secondary Education
Doug Christensen, Assistant Superintendent, Human Resources
Ron Cone, Executive Director, Information Technology
Vic Roberts, Executive Director, Business Operations
Robyn Chastain, Director, Communications and Public Relations
Home Language Survey Encuesta del Idioma en el Hogar
Apellido del alumno: Primer nombre: Segundo nombre:
Fecha:
Fecha de nacimiento: Sexo: Grado: Escuela:
Dirección: Teléfono:
Este formulario fue completado por:
Nombre del padre/madre/tutor: Relación con el alumno:
Firma del padre/madre/tutor:
Si está disponible, ¿en qué idioma desea recibir información de la escuela?
¿Su hijo recibió apoyo para el aprendizaje del idioma inglés a través del Programa Estatal de
Educación Bilingüe de Transición en la última escuela a la que asistió? Sí__ No__ No sé__
1. ¿En qué país nació su hijo?
___________________
2. ¿Qué idioma aprendió su hijo primero?*
___________________
3. ¿Qué idioma usa más SU HIJO en casa?* ___________________
4. ¿Qué idioma(s) usan más los padres/tutores cuando hablan con su
hijo?
___________________
___________________
5. ¿Ha recibido su hijo educación formal* fuera de los Estados Unidos? (Kinder a 12.º grado) _____Sí _____No
"Educación formal" no incluye programas en campos de refugiados ni otros programas no acreditados para niños.
En caso afirmativo, ¿en qué
idioma se le dio la
instrucción? ____________
¿Por cuántos meses? _____
6. ¿Cuándo asistió su hijo a la escuela en los Estados Unidos por
primera vez? (Kínder a 12.o grado)
__________________________
Mes Día Año
7. ¿Se mudó usted a esta área con el propósito de buscar trabajo en la
agricultura o trabajo relacionado con la agricultura (por ejemplo:
operación de equipo de siembra/cosecha, proceso de empaque)?
_____Sí _____No
KENNEWICK HIGH SCHOOL
500 South Dayton Street Kennewick, WA 99336 Phone: (509)222-7100
BEHAVIOR EXPECTATIONS
1. Kennewick High has an attendance policy which expects students to attend all classes regularly. At 12 absences, excused or unexcused, students will lose credit in that class.
2. Kennewick, School District strictly forbids alcohol and other drugs on any of its property. This includes all schools, parking lots, and athletic areas. There is a district policy which dictates student consequences for violation of these policies.
3. We have a no tolerance policy toward weapons on school district property. This includes
pocket knives or items which may be used as a weapon. Students will be expelled immediately for possession and/or use of a weapon.
Refer to the student handbook for further expectations. Ignorance is no excuse for not following expectations. I have been advised of school and district expectations concerning behavior, attendance, alcohol and other drugs, and weapons.
______________________________________ _________________________ Student Signature Date
______________________________________ _________________________ Student Name (Printed) Grade Level
______________________________________ _________________________ Counselor Signature Date
KENNEWICK HIGH SCHOOL LEGAL GUARDIANSHIP VERIFICATION REQUIREMENTS
Students entering/attending Kennewick High School must present at the time of registration written proof that they reside with their custodial parent or legal (court mandated) guardian. This proof must be presented before the student is permitted to make an appointment for registration. This Kennewick School District Legal Office has prepared a packet of 3 forms that must be filled out and notarized. We will provide these forms for you if needed. Please follow the guidelines below:
1) Students 18 or over and living on their own must present written proof of residency (rental agreement, recent phone or utility bill, etc.).
2) Students 18 or over living with a custodial parent or legal (court mandated) guardian must present written proof of their parent’s or guardian’s permanent residency (rental agreement, recent phone or utility bill, etc.).
3) Students applying for admission to Kennewick High who do not reside with
their parent(s) must fill out the KSD Forms that are required to be notarized.
RCW 28a.225.330
Enrolling students from other districts — Requests for information and permanent records — Withheld transcripts — Immunity from liability — Notification to teachers and security personnel — Rules. (1) When enrolling a student who has attended school in another school district, the school enrolling the student may request the parent and the student to briefly indicate in writing whether or not the student has: (a) Any history of placement in special educational programs; (b) Any past, current, or pending disciplinary action; (c) Any history of violent behavior, or behavior listed in RCW 13.04.155; (d) Any unpaid fines or fees imposed by other schools; and (e) Any health conditions affecting the student's educational needs. (2) The school enrolling the student shall request the school the student previously attended to send the student's permanent record including records of disciplinary action, history of violent behavior or behavior listed in RCW 13.04.155, attendance, immunization records, and academic performance. If the student has not paid a fine or fee under RCW 28A.635.060, or tuition, fees, or fines at approved private schools the school may withhold the student's official transcript, but shall transmit information about the student's academic performance, special placement, immunization records, records of disciplinary action, and history of violent behavior or behavior listed in RCW 13.04.155. If the official transcript is not sent due to unpaid tuition, fees, or fines, the enrolling school shall notify both the student and parent or guardian that the official transcript will not be sent until the obligation is met, and failure to have an official transcript may result in exclusion from extracurricular activities or failure to graduate. (3) Upon request, school districts shall furnish a set of unofficial educational records to a parent or guardian of a student who is transferring out of state and who meets the definition of a child of a military family in transition under Article II of RCW 28A.705.010. School districts may charge the parent or guardian the actual cost of providing the copies of the records. (4) If information is requested under subsection (2) of this section, the information shall be transmitted within two school days after receiving the request and the records shall be sent as soon as possible. The records of a student who meets the definition of a child of a military family in transition under Article II of RCW 28A.705.010 shall be sent within ten days after receiving the request. Any school district or district employee who releases the information in compliance with this section is immune from civil liability for damages unless it is shown that the school district employee acted with gross negligence or in bad faith. The professional educator standards board shall provide by rule for the discipline under chapter 28A.410 RCW of a school principal or other chief administrator of a public school building who fails to make a good faith effort to assure compliance with this subsection. (5) Any school district or district employee who releases the information in compliance with federal and state law is immune from civil liability for damages unless it is shown that the school district or district employee acted with gross negligence or in bad faith. (6) When a school receives information under this section or RCW 13.40.215 that a student has a history of disciplinary actions, criminal or violent behavior, or other behavior that indicates the student could be a threat to the safety of educational staff or other students, the school shall provide this information to the student's teachers and security personnel. (7) A school may not prevent a student who is dependent pursuant to chapter 13.34 RCW from enrolling if there is incomplete information as enumerated in subsection (1) of this section during the ten business days that the department of social and health services has to obtain that information under RCW 74.13.631. In addition, upon enrollment of a student who is dependent pursuant to chapter 13.34 RCW, the school district must make reasonable efforts to obtain and assess that child's educational history in order to meet the child's unique needs within two business days.
In order to preserve an educational environment conducive to teaching and learning, our staff looked at ways to limit the use of electronic devices without completely eliminating them from campus. We understand that there are times when parents need to communicate with their students and we undestand that electronic devices can be used at times as a tool to enhance education. We tried to balance this need with the needs of the teacher to not have interruptions and distractions that impede a student’s ability to learn.
Electronic Policy
Electronic devices cannot be used at any time for illegal activities, violation of school rules, or to violate the privacy of others. Violations on this level will be treated as a disciplinary issue. To preserve an appropriate learning environment, video games, MP3, Ipods, cell phones and other electronic devices may not be used in any location during class time (classrooms, hallways, bathrooms, etc.) and must be turned off. Electronics will be permitted between classes, lunch, before and after school. Exceptions would be if used as a classroom tool as written in to a teacher’s classroom expectation approved by the principal, or emergency situations with teacher approval. Please note that if you need to contact your student during school hours, you can always call the attendance office at 222-5140 or 222-5207 and we will get a message to your student. This policy has been set up with your studen’t success in mind. We value our teacher’s time and the time that students are in class, and we are making every effort to make sure that when they are in class, there are the least number of of distractions and fewer reasons to leave class. If you have any questions about this policy, please call the main office number at 222-7100.