Welcome to the Wilmington Area School District Enrollment Packet Jeffrey A. Matty, Ed.D. Superintendent (724) 656-8866 www.wasd.school Education Is Our #1 Priority
Nov 01, 2019
Welcome to the
Wilmington Area
School District
Enrollment Packet
Jeffrey A. Matty, Ed.D. Superintendent
(724) 656-8866
www.wasd.school
Education Is Our #1 Priority
The information in this enrollment packet is a brief look at the district. You will receive additional information the first week of school. Please fill out the forms included in this packet and return them to Mrs. Carolyn Huff or Mrs. Melda Irwin at the District Administration Office. If you have any questions regarding the enrollment process, feel free to contact either Mrs. Huff at (724) 656-8866 x 6000 or Mrs. Irwin at (724) 656-8866 x 6100. You may also visit the website at www.wasd.school for additional information.
Overview
The Wilmington Area School District is located in the northern portion of Lawrence County and part of Mercer County. It consists of the following townships and boroughs: Washington Township, Plain Grove Township, Wilmington Township (Mercer and Lawrence Counties), Pulaski Township, Volant Borough and New Wilmington Borough. The district has an elementary school, a middle school and a high school. The enrollment is approximately 1150 (Gr. K-12).
Building Information
Wilmington Area School District 300 Wood Street
New Wilmington, PA 16142 Phone: (724) 656-8866 x 6000
FAX: (724) 946-8982
Business Hours: 8:00 a.m. – 4:00 p.m.
Title Name Email Phone
Extension
Superintendent Dr. Jeffrey Matty [email protected] 6000
Business Manager/ Board Secretary
Mr. Joshua Latore [email protected] 6200
Special Education Supervisor
Miss Mary Anne Grubic [email protected] 6502
School Psychologist
Dr. Michael O’Donovan [email protected] 6504
Director of Curriculum & Instruction
Mr. Ken Jewell [email protected] 6600
Food Service Director
Mr. Ed Freer [email protected] 6075
Enrollment Secretary
Mrs. Carolyn Huff [email protected] 6000
Enrollment Secretary/ Volunteers/ Clearances
Mrs. Melda Irwin [email protected] 6100
Wilmington Area Elementary School (Gr. K-4) 450 Wood Street
New Wilmington, PA 16142 Phone: (724) 656-8866 x 3000
FAX: (724) 946-8259
Start Time: 9:00 a.m. – Dismissal Time: 3:45 p.m.
Title Name Email Phone
Extension
Principal Mr. Robert Kwiat [email protected] 3010
Special Education Supervisor
Miss Mary Anne Grubic [email protected] 6502
Guidance Mrs. Valerie Lewis [email protected] 3020
Nurse Mrs. Anna Daugherty [email protected] 3030
Secretary Mrs. Marlene Hauger [email protected] 3000
Secretary Mrs. Julie Shenker [email protected] 3001
Wilmington Area Middle School (Gr. 5-8) 400 Wood Street
New Wilmington, PA 16142 (724) 656-8866 x 2000
Start Time: 7:45 a.m. – Dismissal Time: 2:35 p.m.
Title Name Email Phone
Extension
Principal Mr. George Endrizzi [email protected] 2010
Special Education Supervisor
Miss Mary Anne Grubic [email protected] 6502
Guidance Mrs. Kim Telesz [email protected] 2020
Nurse Mrs. Sarah Vincent [email protected] 1030
Secretary Mrs. Paula Woods [email protected] 2000
Wilmington Area High School (Gr. 9-12) 350 Wood Street
New Wilmington, PA 16142 (724) 656-8866 x 1000
Start Time: 7:45 a.m. – Dismissal Time: 2:35 p.m.
Title Name Email Phone
Extension
Principal (Gr. 9-12) Mr. Michael Wright [email protected] 1010
Special Education Supervisor
Miss Mary Anne Grubic [email protected] 6502
Guidance Ms. Taryn Powell [email protected] 1020
Guidance Secretary Mrs. Becky Hoppe [email protected] 1001
Nurse Mrs. Sarah Vincent [email protected] 1030
Athletic Director Miss Brandy Sanford [email protected] 1050
Secretary Ms. Connie Cassella [email protected] 1000
Secretary Ms. Mary Saterlee [email protected] 1021
Transportation Contacts
.
Title/Company Name Email Phone
Transportation Coordinator
Mrs. Melda Irwin [email protected] (724) 656-8866
ext. 6100
Krise Transportation, Inc. (Busing)
Mr. Earl Hogue [email protected] (724) 901-7126 (724) 901-7129 (724) 977-3632
WILMINGTON AREA SCHOOLS
ENROLLMENT OF NEW PUPILS ═══════════════════════════════════════════════════════════════════════ Pupil's Name Sex M F (Last) (First) (Middle) Address (Street/Road/PO Box)
City State Zip Telephone
Township/Boro: Pulaski Twp. Wilmington Twp. Volant Boro New Wilmington Boro Washington Twp. Plain Grove Twp.
County: Lawrence Mercer
Date of Birth Birth Certificate No.
Place of Birth (Name of Hospital) (City) (State)
*If your child was born outside of PA, list date they first resided in PA: (mm/dd/yyyy)
Ethnicity: 1. Amer. Indian/Alaskan Native (not Hispanic) 3. Black or African American (not Hispanic) 4. Hispanic (any race) 5. White (not Hispanic) 6. Multi-Racial (not Hispanic) 9. Asian (not Hispanic) 10. Native Hawaiian or other Pacific Islander (not Hispanic)
Living with: Mother Father Both Guardian Foster Other
═══════════════════════════════════════════════════════════════════════ Father Guardian Foster Information (circle one)
Name Last First M.I. Address City State Zip Home Telephone Cellular Telephone Occupation Employer Work Telephone Email Address
Mother Guardian Foster Information (circle one) Mrs. Ms. Miss Name Last First Maiden Name Address City State Zip Home Telephone Cellular Telephone Occupation Employer Work Telephone Email Address
Step Father: Step Mother
═══════════════════════════════════════════════════════════════════════ Are there any court documents regarding your child? Yes No CUSTODY PAPERS ON FILE – Date Other children in the family or living at the above address:
NAME (First and Last) SEX DATE OF BIRTH SCHOOL GRADE RELATIONSHIP
Last School Attended: Grade
School Address: Telephone: ( )
City State Zip Date of Withdrawal:
Previous Schools attended: Parent/Guardian Signature Date
═══════════════════════════════════════════════════════════════════════ For Office Use Only
Resident/Non-Resident Information (Check all that apply) Entry Information – Must be mm/dd/yyyy format only.
PA Secure ID # Grade Homeroom/Teacher Student Number Locker Number
Required for all students
Grade 09 Entry Date __________
District Entry Date ______________
School Entry Date __ ___________ _
State Entry Date
Only if student is an immigrant, migrant or ELL:
Date Entered School in USA
Years in US School
Please print in blue or black ink.
1306 1305 Foster Child 1302 District Paid Tuition Parent Paid Tuition Tuition Waived Homeless
07/2014
Enrollment Checklist
Proof of Residency RESIDENT FAMILIES Any family that claims residency in the school district must upon enrollment in the school district provide proof of residency. Proof of residency shall be one (1) of the following: Property tax form Deed Lease agreement Letter on apartment complex or mobile home park letterhead signed by the landlord Or two (2) of the following: Utility bill(s) Auto registration Bank statement Auto insurance Unemployment/employment check
THE SCHOOL DISTRICT RESERVES THE RIGHT TO INVESTIGATE ANY OR ALL CLAIMS OF RESIDENCY AND TAKE LEGAL ACTION AGAINST ANY PERSON OR PARTY FOUND TO BE SUPPLYING FALSE INFORMATION TO THE SCHOOL DISTRICT.
FOSTER CARE STUDENTS AND INMATES OF INSTITUTIONS – Send the Original to the Superintendent’s
Office – Keep a copy on file in your office. Any student being enrolled in the Wilmington Area School District as a “Foster Care Student” or an “Inmate of an Institution” shall be considered enrolled only after completion, in person, by a representative of the agency making the placement of “Section 1305/1306 Application.” Examples of “Foster Care Students” would be students placed by the Bair Foundation, Lawrence County Children and Youth, etc. An example of an “Inmate of an Institution” would be George Junior Republic Halfway House Resident. “Foster Care Students” are covered by Section 1305 of the School Code and “Inmates of Institutions” are covered by Section 1306 of the School Code.
AFFIDAVIT STUDENTS AND FOREIGN EXCHANGE STUDENTS– Send the Original to the Superintendent’s
Office – Keep a copy on file in your office. Any student being enrolled in the Wilmington Area School District as an “Affidavit Student” or as a “Foreign Exchange Student” shall be considered enrolled only after completion of a “Section 1302 Affidavit,” signed and notarized. Examples of “Affidavit Students” would be a relative taking in another relative due to family problems. An example of a “Foreign Exchange Student” would be a student attending school through an AFS, Rotary, Etc. program.
IMMUNIZATION RECORDS
SCHOOL RECORDS
HAS THIS STUDENT EVER BEEN ENROLLED IN THE WILMINGTON AREA SCHOOL DISTRICT?
Yes No
HAS THIS STUDENT EVER RECEIVED ANY OF THE FOLLOWING SPECIAL SERVICES:
Educational Speech Vision Hearing Title I (Reading/Math)
Wilmington Area School District 300 Wood Street
New Wilmington, PA 16142
Telephone: (724) 656-8866
FAX: (724) 946-8982
www.wasd.school
Home Language Survey*
The Office of Civil Rights (OCR) requires that school districts/charter schools/full day AVTS identify limited English proficient (LEP) students in order to provide appropriate language instructional programs for them. Pennsylvania has selected the Home Language Survey as the method for the identification.
Date: School: Wilmington Area Elem. School Wilmington Area Middle School
Wilmington Area High School Other Student’s Name: Grade: 1. What is/was the student’s first Language?:
2. Does the student speak a language(s) other than English? Yes No
(Do not include languages learned in school.)
If yes, specify the language(s):
3. What language(s) is/are spoken in your home?
4. Has the student attended any United States school in any 3 years during his/her lifetime?
Yes No
If yes, complete the following:
Name of School State Dates Attended
Person completing this form (if other than parent/guardian): Parent/Guardian Signature: *The school district/charter school/full day AVTS has the responsibility under the federal law to serve students who are limited English proficient and need English instructional services. Given this responsibility, the school district/charter school/full day AVTS has the right to ask for the information it needs to identify English Language Learners (ELLs). As part of the responsibility to locate and identify ELLs, the school district/charter school/full day AVTS may conduct screenings or ask for related information about students who are already enrolled in the school as well as from students who enroll in the school district/charter school/full day AVTS in the future.
Wilmington Area School District 300 Wood Street
New Wilmington, PA 16142
Telephone: (724) 656-8866
FAX: (724) 946-8982
www.wasd.school
Registration Statement
(Please print)
Student’s Name: D.O.B.: As required by Act 26 of 1995, Sections 1304-A, it is required that prior to admission to any school entity, the parent, guardian or other person having control or charge of a student shall, upon registration, provide a sworn statement or affirmation stating whether the pupil was previously suspended or expelled from any public or private school of this Commonwealth or any other state for an act or offense involving weapons, alcohol or drugs, or for the willful infliction of injury to another person or for any act of violence committed on school property. Any willful false statement made under this section shall be a misdemeanor of the Third Degree. TO FULFILL THE REQUIREMENTS OF THE LAW YOU ARE REQUIRED TO COMPLETE ONE OF THE TWO STATEMENTS BELOW. I hereby swear or affirm, under penalty of law that the above named student has not been previously suspended or expelled from any public or private school of the Commonwealth or any other state for an act or offense involving weapons, alcohol or drugs, or for the willful infliction of injury to another person or for any act of violence committed on school property.
Parent/Guardian Signature: Date: Print Parent/Guardian Name: I hereby swear or affirm, under penalty of law that the above named student has been previously suspended or expelled from the School District for an act or offense involving weapons, alcohol or drugs, or for the willful infliction of injury to another person or for any act of violence committed on school property.
Parent/Guardian Signature: Date: Print Parent/Guardian Name:
Date Records Sent For:___________ Requested by:__________ Date Records Rec’d___________
Wilmington Area School District 300 Wood Street
New Wilmington, PA 16142
Telephone: (724) 656-8866
FAX: (724) 946-8982
www.wasd.school
Request for Student Records
Please use this form to request records from other schools and facilities.
(Please print)
Last Name: First Name:
Date of Birth: Sex: Male Female Grade:
Name of Last School Attended:
School Address:
School Phone: FAX:
PA Secure ID Discipline Records
Permanent School Records Special Education Records (Evaluation
Reports and Individual Education Plans)
Health Records Standardized Test Data
Cumulative Records Other:
Wilmington Area School District Wilmington Area Elementary School
Attention: Mrs. Carolyn Huff Wilmington Area Middle School
300 Wood Street Wilmington Area High School
New Wilmington, PA 16142 Other
(724) 656-8866 x 6000
Signature of Parent/Guardian: Date:
Telephone #: Cell #:
Information Requested
Student
Record Request
Send Records To
Authorization to Release Student Records
WILMINGTON AREA SCHOOL DISTRICT
Student Residency Questionnaire
Dear Parent or Guardian, The McKinney-Vento Act, as amended by the No Child Left Behind Act of 2001, defines homelessness and outlines the rights or homeless students. Your responses to these questions will help staff determine what residency documents are necessary for enrollment of your child/children. Thank you for your cooperation. Student name: Date of Birth: Person completing form: Relationship to child: In what type of setting is the student living now?
Check one box below either in Section A or Section B: SECTION A SECTION B
In an emergency or transitional shelter
Sharing the housing of other persons due to loss of housing,
economic hardship, or similar reason
In a motel, hotel, campsites, or cars due to a lack of
alternative adequate accommodations
In a car, park, public spaces, abandoned building,
substandard housing, bus or train stations, or similar settings
Other places not designed for, or ordinarily used as, a
regular sleeping accommodations for human beings
If you checked any box in Section A, continue completing the
information below.
None of the choices in Section A apply.
If you checked this section, you do not need to complete the remainder of this form. Submit the form to school personnel now.
Contact number for person completing the form: ( )
Address where student is now living:
The student lives with: (Check all that apply)
Parent(s) or legal guardian Relative, friend(s), or other adult(s)
Alone Other:
Over
School student attended last:
Address of school:
Telephone number of school:( )
Contact person at school (if known):
Does the student have an IEP or a Chapter 15/504 agreement?
No
Yes, please explain:
The staff person who is helping you register will contact the homelessness coordinator to review
the information provided. If homelessness is verified, additional information will be needed to
complete enrollment. The homelessness coordinator will contact you by the end of the next
school day (or sooner) to share the determination regarding homeless status, to gather
additional information and to discuss the plans for placement.
Signature of Parent/Legal guardian:
Date:
FOR OFFICE USE ONLY
NOTE TO STAFF: All forms with a checked box in Section A are to be faxed immediately to the Homeless Liaison to eliminate any delay.
Name of person contacting parent
Date parent was contacted
Determination of homeless status
Date homeless student was enrolled
Additional information
Signature Date
Transportation Information This information will be given to the bus contractor and your child’s bus driver.
Date Entered
Student’s Last Name First Name
Grade Building D.O.B. Sex
Street Address
City State Zip
Telephone - Home Work
Parent or Guardian
Please list any concerns or medical conditions (allergies, bee stings, asthma, seizures, etc.) that the driver should
be aware of:
Style of your house: One Story Two Story Mobile Home Other
Brick Siding Stone Other
Color of your house:
Please give the location of your house from either direction: (such as, fourth house on the left from Route 208 or
second on the right from Marr Rd.):
Additional Information:
Parent/Guardian Signature Date
If your child is to be picked up or dropped off at a location other than your home address, you must complete an Alternate Bus Stop Request Form. Please contact Melda Irwin, Superintendent’s Secretary at (724) 656-8866 ext. 6100 to request a form.
PLEASE PRINT
WILMINGTON AREA SCHOOL DISTRICT Health Emergency Information
Name M F Grade/Teacher
(Last) (First) (Middle) Sex
Telephone Date of Birth
Custody Papers On File – Date
Father’s Information Mother’s Information Mrs. Ms. Miss
Name Name
Last First M.I. Last First M.I.
Address Address
City City
State Zip State Zip
Home Telephone Home Telephone
Cellular Telephone Cellular Telephone
Father’s E-mail Mother’s E-mail
Employer Employer
Employer’s Address Employer’s Address
Work Telephone Work Telephone
Living with: Father Mother Both Other
Step Parent:
When there is an emergency we always try to contact the parent first. However, please list names, addresses and phone
numbers of two relatives, friends or neighbors we might call in case we cannot contact the parent. Indicate their relationship to
the student.
1. Emergency Contact Person 2. Emergency Contact Person
Relationship Relationship
Name Name
Last First M.I. Last First M.I.
Address Address
City City
State Zip State Zip
Home Telephone Home Telephone
Cellular Telephone Cellular Telephone
Family Physician Physician’s Telephone
Family Dentist Dentist’s Telephone
Do you have a hospital preference: Yes No If yes, where?
Please list other children in family:
Name Birthdate Grade Name Birthdate Grade
Please Check off the medications your child CANNOT receive in school. Permission to give:
Benadryl (allergic reactions) Acetaminophen (Tylenol) Ibuprofen Mylanta/Tums
Antibiotic Ointment (bacitracin) Cough Drops Orajel
I voluntarily consent to emergency treatment, first aid, and screening examinations as may be deemed necessary by the school
physician, nurse, and state mandates. Please check one: Yes No
When unable to contact parent or personal physician, I hereby voluntarily consent to the school physician to authorize treatment
needed at a local hospital, until the parent or personal physician can be reached.
Please check one: Yes No
Do you want this student to receive Fluoride Tablets (grades K-4). Please check one Yes No
(New Wilmington Boro, Volant Boro, Aqua Water Customers in Village of Pulaski, and Shenango Valley Water contain Fluoride).
If no, does your child receive fluoride at home in any of the following: Vitamins Water Other None at all
(See Page 2) Revised 9-16
Parent/Guardian Signature Date (Over)
Wilmington Area School District
Health Inventory
Grade Teacher List medications taken at home:
Student Health Does your child have any problems, which may affect his/her learning in school, cause any concern and/or may be
important for the school staff to know? Please check “yes” or “no” for each of the following health areas:
Yes No
Childhood diseases (e.g. Chicken Pox, Measles, Mumps, etc.)
General Health (e.g. fatigue, low energy level, poor sleep habits,
frequent illness, poor posture)
Specific physical condition/illness past or present (e.g. cerebral palsy,
Seizure disorder, back abnormality, sickle cell anemia, diabetes, heart problem,
Asthma, etc.)
ADD/ADHD
Allergy (e.g. insect stings, foods, drug, environmental) and symptoms
Vision/Eye (e.g. contact lens, glasses, uncorrectable condition, surgery)
Hearing/Ear (e.g. frequent infections, draining ear, hearing aids)
Speech (e.g. delay, stammer, hard to understand)
Development (e.g. slow in walking, speaking, or growing, etc.)
Nutrition (e.g. over or under weight, poor eating habits, anemic)
Alcohol, tobacco, or drug use
Behavior/personal relationships (e.g. very active, easily upset,
needs to be center of attention, loner, shy, has difficulty making friends)
Other (e.g. recent family crisis, job after school, time consuming hobby)
If female: Menstrual (e.g. pain, irregularity, late or early onset)
Remarks: Please explain any “yes” answers or any comments that would be of importance for school personnel to know.
Allergies
If you would like to discuss your child’s health with school personnel, please check title:
Nurse assigned to school Teacher Counselor Principal
If your child has any special medical problems, conditions or any restriction on physical activities, please explain.
I understand that unless otherwise notified, the school nurse will share this information on a confidential basis with
administrators, professional personnel, and support staff members having direct contact with your child to ensure that
his/her health and safety is protected.
Parent/Guardian Signature Date
Anna Daugherty, CSN Elementary School Nurse (ext. 3030) Sarah Vincent, CSN MS/HS School Nurse (ext. 1030)
Interval or Update Health History
To be complete by parent/guardian.
Please print. Student Last Name First Date of Birth Grade School: Pulaski Elementary New Wilmington Elementary
Middle School High School Other 1. Has your child been in good health the past year? Yes No
If no, please explain
2. Has your child had any of the following in the past year:
a) illness lasting more than three (3) days Yes No b) severe injuries or accidents Yes No c) fractures or broken bones Yes No d) sprains or strains Yes No e) time in a hospital Yes No f) operations Yes No g) drugs or treatments prescribed by a physician or clinic Yes No
If yes to any of the above, please explain
3. a) Is your child under the care of a physician or clinic now? Yes No
b) Is your child taking any treatments, or medications now? Yes No c) Does your child use an inhaler? Yes No
If yes to any of the above, please explain (list medications)
Please see PAGE 2
4. Does your child have any allergies to: a) medications Yes No b) foods Yes No c) insects Yes No d) bee stings Yes No c) other Yes No If yes to any of the above, please explain Does it require emergency medication? Yes Medication No
5. In the past year, have you noticed that your child has any of the following problems?
a) trouble with eyes or seeing Yes No b) started wearing glasses Yes No c) started wearing contacts Yes No d) trouble with ears or hearing Yes No e) trouble with allergies Yes No f) trouble with asthma or breathing Yes No g) trouble with eating or with weight loss or gain Yes No h) trouble with sleeping Yes No i) trouble keeping up with activities of his/her friends Yes No j) trouble with class work Yes No k) trouble with school Yes No l) trouble with family Yes No m) problems with general development and maturity Yes No
6. a) has your child seen a dentist in the past year Yes No b) describe the state of your child’s teeth: Teeth missing None Some All Teeth decayed (cavities) None Some All Teeth filled None Some All 7. Has your child had any immunizations the past year? Yes No If yes, please explain
8. Has any member of the family developed any serious health problem in the past year? Yes No If yes, please explain
9. Do you think your child is fit to participate in all school sports, athletics and gym class? Yes No 10. Do you have any concerns regarding your child which you would like to discuss with the school nurse? Yes No Parent/Guardian Signature Date
WILMINGTON AREA SCHOOL DISTRICT 300 WOOD STREET
NEW WILMINGTON, PA 16142 (724) 656-8866
WWW.WASD.SCHOOL
PERMISSION TO BE PHOTOGRAPHED
Dear Parents or Guardian, Throughout the school year there may be times when the students are photographed during classroom activities. These pictures may be submitted with classroom articles and published in the local newspapers and/or the district website. Your permission is necessary for us to photograph your child during these times. Please have your child return this signed permission form to their homeroom teacher.
Student’s Name: Grade: _______ Student’s Homeroom Teacher: ____________________________
My child’s photograph MAY BE used as part of news releases and/or publications.
My child’s photograph MAY NOT BE used as part of news release and/or publications.
My child’s photograph MAY BE used as part of the district website.
My child’s photograph MAY NOT BE used as part of the district website. Parent/Guardian Signature: Date: ________
This form applies to pictures taken during regular school activities for the purpose of possible publication. It does not apply to scheduled school pictures, extra-curricular activities where pictures are taken by newspaper photographers, or pictures taken for the yearbook.