Student Enrollment Information Milton High School 13025 Birmingham Highway Milton, GA 30004 Phone: 770-740-7000 Fax: 770-667-2888 o Required Paper work from previous school: WITHDRAWAL FORM (Unless transferring during the summer) COPY OF TRANSCRIPT (With complete mailing address of school last attended) ATTENDANCE RECORD DISCIPLINE RECORD o Required paperwork from Parent/Guardian: o VERIFICATION OF RESIDENCY – Need one document from List A and one document from List B A. One document must be from the list below with the parent or guardian’s name and current address: Copy of home mortgage bill Valid Driver’s License/State ID Copy of home sale contract Section Eight/HUD Housing Document Homeowner’s/Renter’s Insurance registration card Current bank statement Current Paycheck Current HOA Bill Current Apartment/House Lease B. One document must be from the list below with the parent or guardian’s name and current address: Current Water bill Current Electric bill Current Gas Bill o IMMUNIZATION RECORDS - Georgia Immunization Certificate (form 3231 Rev. 7/2014). (contact the North Fulton Regional Health Center at 404-332-1958) o CERTIFICATE OF VISION, HEARING, DENTAL, AND NUTRITION SCREENING (form 3300 Rev. 2013) (contact the North Fulton Regional Health Center at 404-332-1958) o SOCIAL SECURITY CARD o BIRTH CERTIFICATE – state issued (hospital certificates not acceptable) o PROOF OF CUSTODY- if you are NOT the natural parents (contact the Probate Court at 404-613- 7638) o IEP OR 504 PLAN – if applicable
12
Embed
Student Enrollment Information · Student Enrollment Information Milton High School 13025 Birmingham Highway Milton, GA 30004 Phone: 770-740-7000 Fax: 770-667-2888 o Required Paper
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Student Enrollment Information
Milton High School 13025 Birmingham Highway
Milton, GA 30004 Phone: 770-740-7000 Fax: 770-667-2888
o Required Paper work from previous school:
WITHDRAWAL FORM (Unless transferring during the summer)
COPY OF TRANSCRIPT (With complete mailing address of school last attended)
ATTENDANCE RECORD
DISCIPLINE RECORD
o Required paperwork from Parent/Guardian:
o VERIFICATION OF RESIDENCY – Need one document from List A and one document from List B
A. One document must be from the list below with the parent or guardian’s name and current address:
Copy of home mortgage bill
Valid Driver’s License/State ID
Copy of home sale contract
Section Eight/HUD Housing Document
Homeowner’s/Renter’s Insurance registration card
Current bank statement
Current Paycheck
Current HOA Bill
Current Apartment/House Lease
B. One document must be from the list below with the parent or guardian’s name and current address:
Current Water bill
Current Electric bill
Current Gas Bill
o IMMUNIZATION RECORDS - Georgia Immunization Certificate (form 3231 Rev. 7/2014). (contact the North Fulton Regional Health Center at 404-332-1958)
o CERTIFICATE OF VISION, HEARING, DENTAL, AND NUTRITION SCREENING (form 3300 Rev. 2013) (contact the North Fulton Regional Health Center at 404-332-1958)
o SOCIAL SECURITY CARD
o BIRTH CERTIFICATE – state issued (hospital certificates not acceptable)
o PROOF OF CUSTODY- if you are NOT the natural parents (contact the Probate Court at 404-613-7638)
(1)STUDENT INFORMATION Print All Information Clearly.
_______________________________________________ _________________________________________ Circle One In This Group: SEX: M - MaleStudent's Last Name First Name Middle Name Generation (ex. JR,III) F - Female
_________________ _____/_____/_____ _____________________________ Is this student Hispanic/Latino? (Choose only one)Preferred Name Month/ Day /Yr of Birth Student's Social Sec. # No, not Hispanic/Latino
Yes, Hispanic/LatinoHome Address: _______________________________________________________________________ Street # and Name P.O. Box if App. Apt. # City Zip +4 What is the student's race? (Choose one or more)
1 - American Indian or Alaska NativeHome Phone: ( ) _______________________ Complex/Subdiv.Name: ______________________ 2 - Asian
3 - Black or African AmericanSchool system of residence if other than Fulton:_________ RESTRICT DIRECTORY INFORMATION? Y N 4 - Native Hawaiian or Other Pacific IslanderCounty of residence if other than Fulton: ________________ 5 - WhiteName of School Serving area in which student lives: _______________
(2)PARENT/GUARDIAN INFORMATION (Complete a box for each parent, step-parent, or guardian; add page if necessary)
Name:__________________________________________ Name:__________________________________________ Name:__________________________________________ Last First MI Suff. Last First MI Suff. Last First MI Suff.Home Address & Phone If Different From Student's Home Address & Phone If Different From Student's Home Address & Phone If Different From Student'sAddress: ______________________________________Address: ________________________________________ Address: ______________________________________City/State/Zip+4: ______________________________________City/State/Zip+4: _________________________________________ City/State/Zip+4: ______________________________________Home Phone: ( ) _________________________________Home Phone: ( ) ____________________________________Home Phone: ( ) ________________________________Alt/Cell Phone: ____________________________________Alt/Cell Phone: ______________________________________ Alt/Cell Phone: ____________________________________Occupation: ______________________________________ Occupation: _________________________________________ Occupation: ______________________________________Business Name: ___________________________________Business Name: ______________________________________Business Name: __________________________________Business Address: ________________________________ Business Address: ___________________________________ Business Address: ________________________________City/State/Zip+4: __________________________________City/State/Zip+4: _____________________________________City/State/Zip+4: _________________________________Business Phone: ( ) ______________________________ Business Phone: ( ) _________________________________ Business Phone: ( ) ______________________________Circle Relation to Student: Mother,Father, Stepmother, Circle Relation to Student: Mother,Father, Stepmother, Circle Relation to Student: Mother,Father, Stepmother,Stepfather, Legal Guardian,Other Stepfather, Legal Guardian,Other Stepfather, Legal Guardian, OtherContact w/student is allowed? Y N Contact w/student is allowed? Y N Contact w/student is allowed? Yes NoResides with this parent/guardian? Y N Resides with this parent/guardian? Y N Resides with this parent/guardian? Yes NoParent/guardian is responsible for student? Y N Parent/guardian is responsible for student? Y N Parent/guardian is responsible for student? Yes NoWorks for federal gov't or on federal property? Y N Works for federal gov't or on federal property? Y N Works for federal gov't or on federal property? Yes NoEmail__________________________________________ Email__________________________________________ Email____________________________________________
(3)MEDICAL/EMERGENCY INFORMATION (4)ENROLLMENT INFORMATIONFamily Physician Has student ever attended a Fulton County School? Yes NoFirst/Last Name: ____________________________________ Physician's Phone: ( )_____________________ext._____ If no, Non-Ful.Co. prior school name: ______________________Insurance/Health Coverage: _______________________________________________________________________ City & State of prior school: _________________________Note medical problems, medication requirements, life-threatening allergies, and other special instructions: Enrolled from ____/____/____ to ____/____/________________________________________________________________________________________ If yes, give name of school(s): _____________________________
____________________________________________________________________________________ y ________________________________________________________________________________________________________________________ Date first entered a USA School (mm/dd/yy) ______________The persons below have authorization to pick-up my child during school hours and can be reached at the numbers listed.FirstName,LastName Phone Number Ext. Relationship Chk out of School? Entry Codes: (Circle One)__________________________ ( ) ________________ ____________ ______________ Y N C Continue in same school W Admitted under SB10__________________________ ( ) ________________ ____________ ______________ Y N U From within system X Admitted under USCO
List Siblings in THIS school: T From another GA public school A From a home school
O From another state or country N Never attended school
(5) REQUIRED INFORMATION P From a private school S Re-entry after illness
Active Military Yes No B Previously WD from this school & year I Re-entry after incarceration
V Admitted under School Choice R Re-entry other
Active Military indicates whether the student has a parent or guardian who is active in US Armed Forces, (6) MANDATORY FOR ALL STUDENTSincluding the National Guard or Reserve Forces. To provide your child with the best possible education, we need to determine
how well he or she speaks and understands English. This survey assists school
(7)FOR SCHOOL USE ONLY personnel in deciding whether your child may be a candidate for additional
Immunization Code (Circle One) Student has met the following requirements: English language support. Final qualification for language support is basedE - Medical Exemption Ear Exam Yes _____ No _____ on the results of an English language assessment.N - GA Requirements Not Met Eye Exam Yes _____ No _____R - Religious Exemption Dental Exam Yes _____ No _____ **Which language does your child most frequently speak at home?
(Primary/Native Language)? ________________________________W - 30-Day, 90-Day, 180-Day Waiver Emer.Sig.Card Yes _____ No _____ **Which language do adults in your home most frequently use when
speaking with your child?Follow-up Date: _____/_____/_____ Birth Certificate Yes _____ No _____ (Home Language)?___________________________________
**Which language(s) does your child currently understand or speak?Y - GA Requirements Met (Correspondence Language) ?__________________________
Has student ever received services in the following programs?High School Course of Study/Graduation Track * Valid only if student entered 9th grade prior to 2009 Gifted Yes No EIP Yes No
Title I Yes No ESOL Yes NoCircle One: **Valid only if student entered 9th grade in 2009 or Remedial Ed Yes No Homeless Yes NoB - Both College Prep. And Career Tech* later 504 Yes NoC - College Preparatory Spec. Educ. Yes No If Yes, Area __________________D - College Prep w/Distinction Date 1st entered 9th grade (mm/dd/yy): ____/___/___ Other Programs (Specify) ____________________________H - Career Tech Prep.**M - College Prep & Career Tech Prep w/Distinction PreK Program Attended: Circle OneN - College Prep w/Distinction & Career Tech. Prep 1. GA PK-Public School 5. Private Non-Profit PKQ - College Prep & Career Tech w/Distinction 2. Public Sponsored PK (Title1) 6. Private For-Profit PKS - Special Education 3. Head Start 7. Did not attend PKU - Career Tech Prep w/Distinction 4. Other Public School 8. GA PK-Private School
Hardship Student (Circle one)
Childcare, Curriculum, Moving,Employee, Medical, Adm.Placement High School Only: I have received a student handbook. Magnet Program Student (Circle one)
Student Signature: Art/Science, Math/Science International Studies, Visual & Performing Arts, International Studies Tuition
Please protect your child against measles, mumps, polio, rubella, whooping cough, diphtheria, hepatitis B
and chicken pox, Meningococcal and Tdap (Tetanus with Pertussis)x. Call your family doctor or the
health center nearest you.
Effective July 1, 2014, all 7th
grade students who were
born on or after January 1, 2002 and for new entrants
grades 8-12 who are entering into a Georgia school for
the first time or entering after having been absent
from a Georgia school for more than twelve months or
one school year will be required to have:
1 Dose of Tdap (Tetanus, Diphtheria, Pertussis
Vaccine)
AND
1 Dose of Meningococcal Conjugate Vaccine
A new Certificate of Immunization Form 3231 (Revised 7/2014) will be
required for students to register for school. The new 3231 Certificate of
Immunization Form will be available and all community providers and
health departments should have access to the form and to GRITS (The
Georgia Registry of Immunization Transactions and Services). Proof of
both vaccinations must be documented on the Georgia Immunization
Certificate (Form 3231).
Certificates issued prior to July 1, 2014 can either be the old form 3231
(Revised 3/2007) or the new form (Revised 7/2014) but it must show proof
of the two vaccinations unless the child has an exemption.
You must check for these vaccines, even if the certificate is marked
complete. If the Certificate is marked complete and the child does not have
these vaccines, he/she must return to his primary care provider or public
health center to receive the vaccines and a new/updated certificate. For more information, visit http://dph.georgia.gov/vaccines-children or call (800)848-3868.
PLEASE NOTE: These changes only affect rising 7th graders (born on or after January 1, 2002),
and students who are considered “new entrants” for grades 8-12.
Certificate of Vision, Hearing, Dental, and Nutrition ScreeningFILE THIS FORM WITH THE SCHOOL WHEN YOUR CHILD IS FIRST ENROLLED IN A GEORGIA PUBLIC SCHOOL
SCREENER CONTACT INFORMATION IS REQUIRED
Child’s Name:__________________________________________________ first middle lastDate of Birth: _____/_____/_____ Gender: Male FemaleChild’s Home Address: ____________________________________________________________________________________street city state zipcode county
Parent/ Guardian Name:_______________________________________ first middle lastParent/ Guardian Contact Information: Daytimephonenumber:_____________________________________________________________Eveningphonenumber:_____________________________________________________________Cellphonenumber:_________________________________________________________________
___________________________________Screener’s Signature DateI certify that this child has received the above screening.Contact Information:
FOR SCHOOL SYSTEM ONLY Follow up for further evaluation
1st attempt 2nd attempt Actions reported (if any)VisionHearingDentalNutritionStudent support services initiated on:
Screeners’ Comments:
DPH Form 3300 Rev. 2013
PLEASE SEE THE INSTRUCTIONS ON THE BACK OF THIS FORM
Georgia Department of Public Health Form 3300 Certificate of Vision, Hearing, Dental, and Nutrition Screening
Who is required to file this Form 3300? The parent or guardian of a child who is being admitted for the first time to a public
school in Georgia must file a completed Form 3300 with the school when the child is enrolled.
What is the purpose of Form 3300? Form 3300 is intended to make sure that every child in Georgia is screened for possible problems with their vision, hearing, teeth and nutrition. The earlier these problems are detected, the earlier parents can seek professional help for the child.
What screenings are required? Four different screenings are required: vision, hearing, dental, and nutrition. All four
screenings must be conducted and reported on the form before it can be filed with the school.
Who can conduct the screenings? Your child’s doctor is authorized to conduct all four screenings, as is your local health department. In addition, the vision screening can be conducted by a Georgia licensed optometrist, an employee of Prevent Blindness Georgia trained to conduct vision screening, or a school registered nurse; the hearing screening can be conducted by a Georgia licensed speech-language pathologist or audiologist, or a school registered nurse; the dental screening can be conducted by a Georgia licensed dentist, dental hygienist, or a school registered nurse; and the nutrition screening can be conducted by a Georgia licensed dietician or a school registered nurse. It is not necessary that the same person conduct all four screenings.
What does “BMI” and “BMI%” mean? “BMI” means “body mass index.” BMI is a way to describe how
much a child weighs in relation to height. “BMI percentile” is a way to compare the child’s body mass index to the body mass index of a healthy child. If the child’s BMI is less than 5% or more than 84% of what is appropriate for his or her age and height, then the child should be taken to a doctor or dietician for a more detailed evaluation. For more information, visit the Centers for Disease Control and Prevention website on child and teen BMI at:
http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html What should a parent do if the “needs further evaluation” box is checked? “Needs further evaluation” means that the child may have a problem. If the “needs further evaluation” box is checked, then the parent should
take the child to a professional for a more detailed evaluation. Your doctor or local health department may be able to help, or recommend someone who can help.
What if a Form 3300 was previously filed for the child at another school? It is only necessary to file the Form 3300 once.
If the Form 3300 is filed at the child’s first school, and the child later transfers to another school, then the original school is required to forward the Form 3300 to the new school.
Georgia High School Graduation Test
All Students who wish to graduate from a public high school in
the state of Georgia must pass all five sections of the Georgia
High School Graduation Test (GHSGT).
Mark with an X each section of the GHSGT that you have
passed. We will also need proof of a passing grade, which
should transfer with the records from your previous school.
GEORGIA HIGH SCHOOL ASSOCIATION TRANSFER STUDENT ELIGIBILITY - FORM B P. O. Box 271, Thomaston, GA 30286 - 706-647-7473 FAX: 706-647-2638
INSTRUCTIONS: This form may NOT be handwritten, and must be submitted for each student who has transferred to your school in the past twelve months from the date of the student transfer. WARNING: Falsification of data on this form may result in institutional penalties such as fine and/or forfeitures of contests. It could result in the student being declared ineligible for any competition for a period of up to two years. It also could result in the transmission of a report of the falsification to the Professional Standards Commission if certified personnel were involved in the falsification.
SECTION A DATE OF THE STUDENT TRANSFER__________________ ACTIVITY ___________________ SCHOOL ____________________________________________ CITY ___________________________ SCHOOL YEAR ____________ ______ In-state Transfer ______ Out-of-state Transfer ______ Approved Foreign Exchange: Program _____________________________ (Complete Section A and B Only)
NAME LAST FIRST MIDDLE
DATE OF BIRTH DATE STUDENT ENTERED 9TH GRADE
UN
ITS
EAR
NED
Pr
ev S
emes
ter
TOTA
L U
NIT
S EA
RN
ED
(This Column for GHSA use only) ELIGIBILITY STATUS Mo. Day Year Mo. Day Year
Beginning & Ending Dates Attended Beginning with 9th Grade (Give month, day, year) Grade Name of School Address (City, State) _____________________________ ___________ ______________________________________ ________________________________________ _____________________________ ____________ ______________________________________ ________________________________________ _____________________________ ____________ ______________________________________ ________________________________________
Previous Home Address: _________________________________________________ ____________________________________________ (Street) (City, State) (County)
Persons Student Lived with at Previous Address: ______________________________ ____________________________________________ (Names) (Relationship)
Is the current residence located in your school service area? __________ Is the custodial parent a certified teacher, counselor or administrator at the receiving school (Grades 9-12)? __________ Was the student suspended or expelled (or facing such penalties) at the former school? (If yes, attach additional information) __________ Does the student qualify for a waiver due to a joint custody or a custody change? (If yes, attach court documents, including judge's signature) __________
SECTION C - Family and Residential Information (Complete only if a bona fide move is claimed)
CURRENT RESIDENCE: Is the current residence being: ______ purchased; ______leased; ______rented? Do you claim multiple residences? ______ If “Yes”, do you claim a Homestead Exemption on this residence? ______ PREVIOUS RESIDENCE: Have you relinquished your previous residence? ______ If "Yes", how was it relinquished? ______ rented previously; ______sold residence or have a contract for sale; ______residence listed for sale at fair market value; ______abandoned the house with unnecessary utilities shut off; ______leased/rented residence at a fair market value. If “Yes”, is the residence being leased/rented to a family member? ______. If “Yes”, please list that individual and relationship: __________________________________________________________________________________________________________. VERIFICATION OF THE BONA FIDE MOVE: (Completed by school personnel) ______Accepted the word of the parent/guardian. ______Conducted a site visit - if "Yes", who made the visit ?_________________ ______Received documentation via utility bill, post office documentation, driver's license, etc. - if "Yes", what document?________________ _________________________________________ ___________________________________ ____________________ (Signed - Principal / Asst. Principal / AD) (Signed – Report Preparer) (Date)