Student Enrollment Information y YPS Employee I o Staff I o Teacher

DAD MIN oCENTRAL oMYERS oPARKLAND o RANCJIWOOD oSHEDECK o SKYVJEW oSURREY o!ES oLES oYMS oYHS

STUDENT INFORMATION

Home School S1te

-:.CENTRAL oMYERS oPARKLAND o RANCHWOOD oSHEDECK o SK I'JIIEW oSURR£ 1' o/ES oLES o i'MS o YHS

LEGAL LAST NAME (Birth Certificate) FIRST NAME MIDDLE NAME

Student's Nick Name Grade Level I jrl\n!IMrtll!lOn for PRE-f.. HI ~OT prO\'Ided

Birth Date Birth Ci Birth State Male Female

ETHNIC RACE CODE- Select all that apply

o Black or African American Native l lawaii/Pacilic Islander o o American Indian or A laskan Native

Is the student Hispanic or Latino Do you have a CDIB card: oYES o NO

RESIDENCY INFORMATION

Address Street City State Zip

Current Address

Mailing Address

Apartment/Housing Addition:

Home Phone: Student Cell:

Student resides with: o Both Parents o Mother/Stepfather/Other o Father/Stepmother/Other

PARENT/GUARDIAN INFORMATION

MILITARY INFORMATION ARMED FORCES RESERVE NATIONAL GUARD YES NO

PARENT/GUARDIAN 1 - Leoal Guard1an last Name First Name Relationship

DOB Cell# Work #

Employer Occupation Primary E-Mail

PARENT/GUARDIAN 2 - Leqal Guardian

Last Name First Name Relationship

DOB Cell # Work #

Employer Occupation Primary E-Mail

PARENT/GUARDIAN 2· ONLY IF DIFFERENT THAN STUDENTS

Address Street City State Zip

Parent/Guardian 2

PARENT ALERT COURT DOCUMENT ON ALE YES OR NO NOTES:

EMEGERNS:Y CONI' A CIS Emergency Contact- other than Parent Relationship Phone Phone Type

QIJIER SZ UJJEN'IJNFS).BM4TION Other Students Attending Yukon Public Schools School Site Relationship UVING IN SAME (ex: Full/Step/Half /Cousin) HOUSEHOLD

YES NO

0 0

0 D 0 0

PREVLOUS S CHOOLJNLORMATION· REQUIRED_

Previous School:

Street: City: 1 State: I Zlp:

Phone: FAX RE{J.UIRED:

GOOD Sl'ANDING VERIFICATION CIRCLE ONE

Is this child currt>ntly under suspension from a previous school

I hcr~.;by certify that the above named student wus withdrawn from the above district in good standing, not under suspension, or pending hearing. If it is cktcm1ined that a good standing verification has been falsified to obtain school admission. the student will be withdrawn

I nan •• ,,an· of lhe Yukon &hoob Board's Pohcy of pro,·•rhng educ<tt1omtl opponunnies only to resickn~>- of the Yukon School 01stlict. My Slgn.tturc vt·rifit•s th.tt my .-hild" legal n:stdcnt nf the Yukon Sdtnol Oi,trict The pcnah~· for l'lllOllmg nn out of distnct student Ill the Yukon Schools may be tuttH•Il ch,trgc for the dav:. .tttcn<kd and/or expulsl()n from the school dist11ct.

======~~~~~~~~ Dnycnrc: Does student attend daycart>

IF so name of daycnrc: ___ _______________ Phone _ _ ______ _ _ ___ _

Medical Alert - Docs this student take prc-;cribnl medication on n regular basis: If yes, Jist

Physical Ltmitations Does this stucknt h:we anv physical limitation~ and/or health problems?

Other Alert:

I?ERMISSION

TO .\TTEND SCHOOL SPONSORED FIELD TRIPS.

TO RECEIVE VISION. HEARING AND ANY OTHER SCREENING TESTS.

TO HAVE ACCESS TO THE YUKON SCHOOLS NETWORK & INTERNET.

CHILD'S PICTURE TO BE USED IN SCHOOL PUBLICATIONS.

TO PUBLISH IMAGE(S) OF MY CHILD'S CLASSWORK. ART OR SCHOOL PRODUCTIONS ON THE WEB SITE.

EXCLUDE FROM SCHOOL DIRECTORY

OPT OUT OF PAPER REPORT CARDS. I WILL USE PARENT PORTAL

HIGH SCHOOL Students ONLY PERMISSION FOR MILITARY OR OTHER AGENCY TO CONTACT MY HIGHSCHOOL STUDENT

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I hereby acknowh:dg(• that I wtll read and discuss the School Student/Parent handbook. My s tudent will be held responsible for respecting and following these rules and rcgulntions. The ru les and rcgulmions for our school nrc l'Xplaincd in this handbook which CWl be found on line at ~v..¥.!Jk.!l.!lPS.CQffi

PARENT OR GUARDIAN SIGNATURE DATE

YUKON PUBLIC SCHOOLS DOES NOT DISCRIMINATE ON THE BASIS OF RACE, COLOR, NATIONAL ORIGIN, SEX, AGE, QUALIFIED HANDICAP OR

VETERAN

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¥ YUKON PUBLIC SCHOOLS

Enrollment Services Division 1000 Yukon Ave., Yukon, OK 73099

Ph: 405.265.1300 I Fax: 405.265.1301 Email: enrollment.center@yukonps.com

Parent's Records Request Student Information

Student Name 008: Grade:

Student Name 008: Grade:

Student Name 008: Grade:

Previous School Information

*Parent is required to provide previous school phone and fax number

School Name

Address City/St/Zip

Phone Fax:

Please include the following documents

0 Withdrawal 0 Unofficial Transcript D Shot Record

0 IEP/504 0 Birth Certificate D Discipline Records

0 Attendance 0 Testing 0 Legal Documents

0 Other:

Parent Request

I am the parent/guardian of the above student(s) and have withdrawn my studcnt(s) from your school di strict. I am in the process of enroll ing my child(rcn ) in Yukon Public Schools. As the parent/guard ian I am ask ing for you to provide Yukon Public Schools Enrolln1ent Center with the above documents.

The documents will provide Yukon Public Schools with verification that my child has offic ially w ithdrawn is in good standing and is not on a suspension.

Parent Signature

Contact Number:

Parent Signature

Date

Yukon Public Schools Enrollment Center- 405-265-1300

Once my studeut(s) eurallmeut It as been completed.

Yu kon Sdwo/s Enrollment Center JVill be faxing au Official Records Request/R I!! ease of Records

Please fax or e-mail requested documents to:

Yukon Schools Enrollment Center Ftt\·: 405-265-1301 A/female Fax: 877-982-7447

Mary.wil liams@yukonps.com Tammi.edwards@yukonps.com

t:nroument :,ervtces utvtston 1000 Yukon Ave., Yukon, OK 73099

Ph: 405.265.1300 I Fax: 405.265.1301 Email: enrollment.center@yukonps.com

Student Name: _ _______________ School Site:--------

The safety of our students is an on-going concern and our district makes every effort to comply with all state and federal regulations regarding this issue. For the protection of your child, we are requesting the following information for our records.

Oklahoma Statutes

Any information or any record relating to a minor child which is available to the custodial parent of the child, upon request, shalf also be provided the noncustodial parent of the child. Provided, however, that this r ight may be restricted by the court, upon application, if such action is deemed necessary in the best interests of the child. For the purpose of this sect ion. "information" and "record" shall include, but not be limited to, information and records kep t by the schoot physician and medical facility of the minor child.

a. Parents are not divorced.

b. __ The parents are divorced. A copy of the current court documents indicating the name of the custodial parent have been provided to the enrollment center and/or school.

c. __ The parents are divorced. A copy of the current court documents indicating joint custody and the name of the primary custodial parent have been provided to the enrollment center and/or school.

d. _ _ The student is living with a person other than a parent. Paperwork in the form of a court documents or DHS custody orders indicating that this is a legal arrangement have been provided to the enrollment center and/or school.

e. __ Legal documents are not available. I understand the school will have to release my child to either parent, on request, without such documents.

f. _ _ I prefer not to provide the school with a copy of legal documents. I understand the school will have to release my child to either parent, on request, without such documents.

g. Parents never married.

ParenULegal Guardian Signature Date Contact#

Oklahoma Law Book Section 14. Residence of Child - Attendance in Transportation Area.

ll. Wh e11 usetl in this section, the residence of a11y child f or school purposes shall be:

The school district in which tlte parents, guardian, or person having legal custody holds legal residence. Custody (as used in A. /) means legal custody; physical custot~l' alone is 1101 .mfficielltto c1ta11ge a child's residency for purposes of admission

to school district.

YUKON PUBLIC SCHOOLS: DISTRJCT POLICY EB Page 2 of 6 - Res idency Requirements

The following students shall be considered legal residents of the District: Students \\lne Jllll1. legal guardian or legal custodian holds legal residence in the District.

www.yukonps.com I #teachandliveyukon

Enrollment Services Division 1000 Yukon Ave., Yukon, OK 73099

Ph: 405.265.1300 I Fax: 405.265.1301 Email: enrollment.center@yukonps.com

Student Enrollment Questionnaire

Student Name: Today's Date: Date of Birth: I Grade: School:

Your chi ld may be eligible for additional educational services through Title X, Part C McKinney­Vente Assistance Act. Eligibility can be determined by completing this questionnaire.

Where are you and your family currently living? Please check one of the boxes below. Section A 0 Rent/own my own home or apartment STOP: lfyou checked the box that you rent/own your own home or apartment skip to the bottom of the page, sign the form, and then submit to school personnel. If you do not rent/own your own home or apartment, please continue to the next sec/ion. Section B 0 Temporarily with another family member or friend until we can locate affordable housing 0 In an emergency or transitional shelter 0 In a vehicle, park, campground, or on the streets 0 In a house, building, or trailer WITHOUT running water or electricity 0 In a hotel or motel 0 With an adult that is not a parent or legal guardian 0 Alone or in different locations, without an adult serving as a caregiver 0 Wherever I can find a place to stay at night 0 Other Please Explain:

If you checked a box in section B, in the space below please list all children currently living with you who attend " name" Public Schools.

First and Last Name of Student Male or Female Date of Birth Grade School Name

Would you like to be contacted by an employee of the school to discuss additional educational services that may be available to your child? DYES DNO

The undersigned certifies that the il?formation provided is correct and accurate.

(Print) Parent/Guardian or Adult Caring for the Student:-------- ------------

Relationship to the Student: ___________ Signature: ----------------

Street Address City State Zip

Phone Number: ____ __________ Email Address:--------- - - ----

Dr. Sheli McAdoo, YPS Homeless Liaison, 405-354-2587; e-mail sheli.mcndoo@ yukonps.com

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OMB Number: 1810-0021 Expirat ion Date: 07/31/2019

U.S. Department of Education

Office of Indian Education

W ashington, DC 20202

TITLE VI ED 506 INDIAN STUDENT ELIGIBILITY CERTIFICATION FORM

Parent/ Guardian: This form serves as the official record of the eligibility determination for each individual child included in the student count. You are not required to complete or submit this form. However, if you choose not to submit a form, your child cannot be counted for funding under the program. This form should be kept on file and will not need to be completed every year. Where applicable, the information contained in this form may be released with your prior written consent or the prior written consent of an eligible student (aged 18 or over), or if otherwise authorized by law, if doing so would be permissible under the Family Educational Rights and Privacy Act, 20 U.S.C. § 1232g, and any applicable state or local confidentiality requirements.

STUDENT INFORM ATION

Name of the Child - --------------------- Date of Birth _ _ _ ___ Grade (As shown on school enrollment records)

NameofSchool ___________________________________ ____ __

TRIBAL ENROLLM ENT

Name of the individual with t ribal enrollment: --------------------- ---------(Individual named must be a descendent in the first or second generation)

The individual with tribal membership is the: Child Child's Parent __ Child's Grandparent

Name of tribe or band for which individual above claims membership: --- ------------- -----

The Tribe or Band is (select only one) : __ Federally Recognized __ State Recognized __ Terminated Tribe (Documentation required. Must attach to form) _ _ Member of an organized Indian group that received a grant under the Indian Education Act of 1988

as it was in effect October 19, 1994. (Documentation required. Must attach to form)

Proof of enrollment in tribe or band listed above, as defined by tribe or band is:

A. Membership or enrollment number (if readi ly available) ---------- ------------- OR

B. Other Evidence of Membership in the tribe listed above (describe and attach) ----------- ----- -

Name and address of tribe or band maintaining enrollment data for the individual listed above:

Name __________ __________ Address ----- --- --------- -----

City ______________ State ___ Zip Code ____ _

ATTESTATION STATEM ENT

I verify that the information provided above is accurate.

Name Parent/Guardian -----------------Signature ------------------

Address ________________ _ City ______ ________ State _ __ Zip Code ___ __

Email Address _ _________________ Date ______ _

Yukon Schools Enrollment Center

1000 Yukon Ave. Yukon OK 73099

Ph: 405-265- 1300 fox : 405-265-1 30 I

www.yukonps.corn

School Health Questionnaire/Yearly Update

(lradc: Student 10:

Dntc Of Bnth.

\lcdh:nllli tory:<.. hc~.:k tf)OUI duld hn' had ;my of the folow111g. Fo1 anything that you mark yes, please explain in the ulmmt·nt att.:a. If you atc unt·omfonablc :Hl~\\Cring any quc~ti on. please ll' rttc "calln11.:" in the comments. and the school nurse '' lfl t·,m t:tt'l 1 ntt. Feel rrt·c to'' 111e more details on the hark. if nccdcd.

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\\'Ill this be giH:n at school? tllu-. ,, 1\0T a p~.:nmsl- ton torm)

YFS NO YES NO YES NO YES NO

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If your child should need any medica lion at school. you" ill need to furnish the medication in the manufacturer' s nriginal l'Ontai ncr or the prescription !Jollie labeled ltpprpriatc f~· by the pha rmacy~ you will need to complete n med ication :wthnri7nlinn form .

Pan·nt Signat u rc: _ ________________ .......:.;Date: ________ _

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