W I C K E N B U R G H I G H S C H O O L 1 0 9 0 S O U T H V U L T U R E M I N E R O A D • W I C K E N B U R G , A Z 8 5 3 9 0

( 9 2 8 ) 6 8 4 - 6 6 0 0 • ( 9 2 8 ) 6 8 4 - 6 6 2 8 F A X w w w . w i c k e n b u r g s c h o o l s . o r g

Preparing Students To Be Productive Citizens In An Evolving World

Students entering Wickenburg High School must provide the following documents. Please bring these items when

you registrar. Missing items can delay the enrollment process. This information will be kept confidential and will be

located in the Records Office. If you have any questions please let us know how we may assist you.

___ Attendance area verification

Current electric, or gas bill with parent/guardian name and service address. OR

Current purchase agreement in parent/guardian name. OR

Closing Statement. OR

Rental/Lease Agreement indicating address, terms, and occupants names. ___ Birth Certificate

Original State issued birth certificate. (A hospital certificate is unacceptable)

Legal name change documentation must be provided if attempting to registrar by name other than

provided on the original birth certificate.

___ Current Photo ID – of registering Parent/Guardian.

Drivers License OR

State Photo ID

___ Custody or Guardianship – Documents required even if you share Joint Custody.

Divorce decree- naming Petitioner/Respondent, indicating custodial parent and include official

signature pages. OR

Court Ordered Guardianship- naming guardians and providing address will student will reside.

OR

CPS Placement- Providing residential address and name authorized caretakers.

If non custodial parent is registering student, custodial parent will authorize non custodial parent

to make all medical and educational decisions for the student while enrolled at WHS by way of a

notarized document. ___ Death Certificate

If biological parent is deceased. ___ Immigration Papers

Copy of current I-94.

___ Immunization Documentation Current immunization records required.

___ Marriage License

Required if parent name change from original birth certificate.

Required if guardian name change from original custody documents issued. ___ School Records

Transcript-unofficial is acceptable for registering.

Withdrawal form – required if registering during current school year.

Certificate of promotion – required for incoming freshman.

Testing – AIMS, (or if out of state – equivalency) Stanford 9, Phlote Scores.

Special Education Records – current IEP, Psychological reports. ___ Athletics

Did you play any sports from your previous school? Y N

Do you plan on playing in any sports? Y N

Wickenburg Unificó el Distrito de la Escuela Wickenburg Educa Alto 1090 S. El buitre Mío

Camino Wickenburg, Az

8539 PH: El FAX del 928-684-6600: 928-684-6628

Los estudiantes que entra Instituto de Wickenburg debe proporcionar los documentos siguientes.

Traiga por favor estos artículos cuando usted registrador. Los artículos perdidos pueden demorar

el proceso de la matriculación. Esta información será mantenida confidencial y será localizado en

la Oficina de Registros. Si usted tiene las preguntas de hormiga permiten por favor que nosotros

saber cómo nosotros le podemos ayudar.

___ Comprobación de área de Asistencia

• Actual eléctrico, o asfixía con gas cuenta con el nombre de padre/guardián y dirección de

servicio. O

• el acuerdo Actual de la compra en el nombre de cría/guardián. O

• Cerrando la Declaración. O • el Acuerdo de Renta/Arrendamiento que indica la dirección, los

términos, y los nombres de ocupantes.

___ Certificado de nacimiento

• el Estado Original publicó certificado de nacimiento. (Un certificado del hospital es

inaceptable)

• la documentación Legal del cambio

del nombre debe ser proporcionada si procurando al registrador por denomina de otra manera que

proporcionado en el certificado de nacimiento original

. ___ Foto Actual identificación – de registrar a Padre/Guardián.

• Conductores Licencian O

• Foto de Estado identificación

___ la Custodia o la Tutela – Documentos requirieron incluso si usted comparta la Custodia

Conjunta.

• El Divorcio decreta- denominando a Peticionario/Demandado, indicando pena de prisión padre

e incluye páginas oficiales de firma. O

• el Tribunal Ordenó la Tutela- denominando a guardianes y proporcionar la dirección hace a

estudiante residirá. O

• la Colocación de CPS- Proporcionando la dirección y el nombre residencial autorizó los

vigilantes.

• Si no padre de pena de prisión registra a estudiante, padre de pena de prisión autorizará no

padre de pena de prisión para hacer todas decisiones médicas y educativas para el estudiante

mientras matriculado en WHS por la manera de un documento notariado.

___ Certificado de defunción

• Si padre biológico es fallecido.

___ Papeles de Inmigración

• Copia de la corriente yo-94.

___ La Documentación de la Inmunización

• los registros Actuales de la inmunización requirieron. ___ Licencia de matrimonio

• Requirió si cría el cambio del nombre del certificado de nacimiento original.

• Requirió si el cambio del nombre de guardián de documentos originales de custodia publicó.

___ Los Registros de la Escuela • Transcribe-NO Oficial es aceptable para registrar.

• Forma de Retirada – requirió si registrando durante año escolar actual.

• Certificado de la promoción – requirió para el estudiante de primer año entrante.

• Probando – los OBJETIVOS, (o si fuera de estado – la equivalencia) Stanford 9, las Cuentas de

Phlote.

• La Educación Especial Registra – IEP actual, los informes Psicológicos.

WICKENBURG UNIFIED SCHOOL DISTRICT #9 REGISTRATION FORM

Student Name Nombre del estudiante Last/apellido First/nombre Middle/medio Other Name or Nickname/apodo

Sex/Sexo: M F Grade Level/grado Age/edad Birthdate/nació

Place of Birth/lugar donde

nació

City/ciudad State/estado County/pais

Birth Certificate/acta de nacimiento Yes/Sí No Residing County/vive en condado

Physical Address / dirección

Mailing Address / dirección del correo (if different / si diferente)

Home Phone Number /teléfono de

casa

Cell Phone / cellular

Has this student ever attended a school in Arizona?

Este estudiante ha asistido siempre a una escuela en Arizona? Yes/Sí No

Number of Years in U.S. Schools

Número de años en escuelas de U.S.

________

Has this student ever attended a school in the Wickenburg School District?

Este estudiante ha asistido siempre a una escuela en el distrito de Wickenburg? Yes/Sí No

Do you have other children attending schools in the Wickenburg District?

¿Tiene otros hijos en las escuelas de el distrito de Wickenburg? Yes/Sí No

Has this Student been enrolled in any of the following programs? ¿Ha asistido este estudiante a uno de estos programas?

Special Education/educación especial ____ Gifted/talentoso ____ Speech/terapeuta de lenguaje ____ ELL ____ Title 1/título 1____

Student Lives with Relationship

Estudiante vive con Names/nombres relación al estudiante

Parent/Guardian’s Name

Nombre de padre o guardian Last / apellido First / nombre Middle / medio

Employer/empleo

Work Phone / teléfono

Spouse’s Name

Nombre de la esposa Last / apellido First / nombre Middle / medio

Employer/empleo

Work Phone / teléfono

Emergency Contact Name and Numbers En caso de la emergencia con exepción de los padres ¿a quién debemos de llamar?

Name / Nombre Phone Number / teléfono Relationship / relación al estudiante

1.

2.

Signature of Parent or Guardian / firma Date / fecha

FOR OFFICIAL USE ONLY / PARA EL USO OFICIAL SOLAMENTE

Below, please indicate one of the following codes: 1. English 2. Spanish 3. American Indian 4. Other

Por favor utilice estos numeros para completer los espacios sigientes. 1. Inglés 2. Español 3. Indio Americano 4. Otro

1. What is the primary language used in the home regardless of the language spoken by the student? ¿Cuál idioma se habla

principalmente en su hogar sin considerar el idioma que habla el estudiante? __________

2. What is the language most often spoken by the student? ¿Cuál idioma habla el estudiante con mayor frecuencia?__________

3. What is the language that the student first acquired? ¿Cuál fue el primer idioma que aprendió el estudiante?__________

Ethnic / la raza _____ 1. White/blanco 2. Black/negro 3. Hispanic/hispáno 4. American Indian/indio 5. Pacific Islander/isleño

Counselor ______________________________ Transportation: Walk ________ Bus ________ Bus # ________

Home Room Number _________ Home Room Teacher _________________________________________________

Tuition District _____________________ Entry Date _____________ Entry Code _________ Attn: Reg _________ Load _______

LIST ALL SCHOOLS THIS STUDENT PREVIOUSLY ATTENDED

Name of School City, State Years attended Reason left

Grade 8 _________________ _____________ _______ __________________________

Grade 9 _________________ _____________ _______ __________________________

Grade 10 _________________ _____________ _______ __________________________

Grade 11 _________________ _____________ _______ __________________________

Grade 12 _________________ _____________ _______ __________________________

Did this student complete school last semester? Yes No

Has this student ever been SUSPENDED or EXPELLED from any school? Yes No

If YES please give date(s) and reason(s). ___________________________________________________________

___________________________________________________________________________________________

Parent/Guardian Signature_______________________________________Date _____________________

EMERGENCY MEDICAL INFORMATION

Student Name _________________________________________ Graduation Year___________

Date of Birth_________________

Does your child have a history of (or currently have) any of the following conditions?

Yes No

Chicken Pox ____ ____

Asthma ____ ____

Diabetes ____ ____

Medical conditions ____ ____ please describe below.

Allergies ____ ____

Medication ____ ____

Bee stings ____ ____

Scorpions ____ ____

Latex ____ ____

List any and all allergies: ________________________________________________________________________

Medical Conditions:___________________________________________________________________________

___________________________________________________________________________________________

Would you like to discuss any of your child’s health history with school personnel? Yes ___ No ___

Phone # __________________

I give my permission for my child to take Acetaminophen/Tylenol (Non Aspirin pain reliever) Yes___ No__

If any over the counter or prescription medicine is needed, a parent must provide medicine in a sealed, un-opened

container. All prescription medication must be in its original bottle from the pharmacy.

Signature of Parent/Guardian ______________________________________ Date___________________

Maricopa County Department of Public Health

Office of Community Health Nursing 602-506-6767 www.maricopa.gov chickenpoxletter-2012

Chickenpox Status Form (Varicella)

Dear Parent: ___________________________ Date:___________________

Beginning September 1, 2011 students entering school in AZ for the first time

need to meet one of the conditions listed below:

Proof of varicella immunization

Valid medical exemption from physician office

Laboratory evidence of immunity to chickenpox

Personal beliefs exemption

The Arizona Department of Health Services ( ADHS) following the Centers for

Disease Control and Prevention (CDC) guidelines has required compliance with

this vaccine (shot) requirement. Please review your student’ record and check the

correct box below and then bring this letter and your student’s vaccination record

to your school health officer prior to the beginning of the school year.

Student’s Name: ___________________ Date of Birth: ________________

Parent Signature: ____________________ Date: ___________________

You need to give this information to your school. Complete this form and bring it to your

student’s school health officer.

**This new ruling does not apply to students who have been attending school in Arizona

prior to September 1st

2011.

Thank you for your cooperation

__Yes, my child has had chickenpox Proof to be obtained from physician letter or blood test (titer)

___Yes, my child received the chickenpox vaccine. Submit vaccine date to school staff

_ No, my child has never had the illness or vaccine for chickenpox Please obtain the vaccination

__I will ask the school health staff regarding obtaining a personal belief exemption for varicella

If you need vaccinations, please contact your private provider or call Community Information

and Referral at 602-263-8856, 800-352-3792 or find them on the web at www.cirs.org

___ Yes, my student has had the chickenpox Shot\Vaccine**

___ No, my student has not had chickenpox. Please obtain the vaccination immediately.

If you need vaccinations, please contact your private provider or call Community Information and

Referral at 602-263-8856, 800-352-3792 or find them on the web at www.cirs.org

___ No, my student has not had EITHER the chickenpox disease or the vaccination. **

**Please note that prior vaccination exemption release forms DO NOT include

chickenpox\varicella. Please contact your school health office to file the appropriate form.

W I C K E N B U R G H I G H S C H O O L 1 0 9 0 S O U T H V U L T U R E M I N E R O A D • W I C K E N B U R G , A Z 8 5 3 9 0

( 9 2 8 ) 6 8 4 - 6 6 0 0 • ( 9 2 8 ) 6 8 4 - 6 6 2 8 F A X w w w . w i c k e n b u r g s c h o o l s . o r g

Preparing Students To Be Productive Citizens In An Evolving World

Dear Parent/ Guardian: (Your signature signifies your agreement to the following policies.) I understand that I may access the Wickenburg High School Handbook on the school’s website at www.wickenburgschools.org and will review the document with my child who is enrolled at the school. By signing this form I understand all rules and policies given therein. Please read all information below and sign in agreement. If for any reason you do not agree to permission for Photo Release, Acceptable Electronic Usage, Student Field Trips, Transportation Authorization, Connect Ed, and handbook rules and regulations, and then please submit a written document stating your formal objection.

Photo Release: Pictures of students and staff can be taken throughout the school year for various reasons such as the yearbook or perhaps a newspaper article covering an activity here at the school. We are asking all parents/guardian to sign this waiver so your child’s photo may be used for the yearbook, newspaper and school board reports. By signing this release you are giving the school your consent to take and use your child’s photo for these purposes.

Electronic Use, Acceptable Use: Each user must:

Use the EIS to support personal educational objectives consistent with the educational goals and objectives of Wickenburg Unified School District. Agree not to submit, publish, display, or retrieve any defamatory, inaccurate, abusive, obscene, profane, sexually oriented, threatening, racially offensive, or illegal material. Immediately inform their teacher if inappropriate information is mistakenly accessed. Abide by all copyright and trademark laws and regulations. Not reveal home addresses, personal phone numbers or personally identifiable data unless authorized to do so designated school authorities. Understand that electronic mail or direct electronic communication is not private and may be read and monitored by school-employed persons. Not use the EIS in any way that would disrupt the use of the EIS by others. Not use the EIS for commercial or financial gain, political lobbying, or fraud. Follow the District’s code of conduct. Not attempt to harm, modify, add, or destroy software or hardware nor interfere with system security. Understand that inappropriate use may result in cancellation of permission to use the EIS and appropriate disciplinary action up to and including expulsion. Be responsible for the appropriate storage and backup of their data. The Wickenburg School District specifically denies any responsibility for the accuracy of information. While the District will make an effort to ensure access to proper materials, the user has the ultimate responsibility for how the electronic information services (EIS) is used and bears the risk of reliance on the information obtained. I understand and will abide by the provisions and conditions indicated. I understand that any violations of the above terms and conditions may result in disciplinary action and revocation of my use of information services. As the parent or guardian of the above named student, I have read this agreement and understand it. I understand that it is impossible for the School District to restrict access to all controversial materials, and I will not hold the District responsible for materials acquired by use of the electronic information services (EIS). I also agree to report any misuse of the EIS to a School District administrator. (Misuse may come in many forms but can be viewed as any messages sent or received that indicate or suggest pornography, unethical or illegal solicitation, racism, sexism, inappropriate language, or other issues described in the agreement.) I accept full responsibility for supervision if, and when, my child’s use of the EIS is not in a school setting. I hereby give my permission to have my child use the electronic information services.

W I C K E N B U R G H I G H S C H O O L 1 0 9 0 S O U T H V U L T U R E M I N E R O A D • W I C K E N B U R G , A Z 8 5 3 9 0

( 9 2 8 ) 6 8 4 - 6 6 0 0 • ( 9 2 8 ) 6 8 4 - 6 6 2 8 F A X w w w . w i c k e n b u r g s c h o o l s . o r g

Preparing Students To Be Productive Citizens In An Evolving World

Field Trips: There are times during the school year when classes are taken on field trips. It is necessary for each student to have parental permission to attend. No student is allowed to attend without a permission slip. You will be sent a written notification prior to each field trip with information regarding each field trip. We are asking that you give permission at this time for any field trips planned during the school year.

Student Transportation: I have read and understand the school bus rules and regulations located in the student

handbook. My student has my permission to use school bus transportation to and from school or in the event of a scheduled field trip. According to state law the responsibility to get each student to and from school rests with the parent. As a courtesy, Wickenburg Unified School District attempts to provide free bus service to students with district boundaries; and we want each student to have a safe and enjoyable trip while on the school bus. Any changes in student scheduling to ride the school bus must be accompanied by written authorization from the parent/guardian.

Connect Ed Communication System: Please indicate which phone numbers and e-mail addresses you want us

to use when contacting you through Connect Ed on the lines provided below. Note: Emergency messages will go out to ALL available numbers. Home Phone#______________________________ Mother’s Day Phone_____________________________ Father’s Day Phone__________________________ E-Mail ________________________________________ Mobile Number for text messages: _____________________________________________________________

Emergency Care Consent: If an emergency involving medical action is required and the parents or guardians

cannot be contacted, I consent for my child to be given medical attention by the doctor selected by the school personnel in charge. Please list family physician and insurance information below.

Name of Physician:_______________________________ Phone#________________ Insurance Company and Policy # ___________________________________________

Student Name: _____________________________________________________________ Student Signature: __________________________________________________________ Print Parent/Guardian Name: __________________________________________________ ______________________________________________ _______________________ Parent/Guardian Signature Date

Wickenburg Unified School District

40 West Yavapai Street Wickenburg, AZ 85390

Phone: 928-668-5350 FAX: 928-668-5390 www.wickenburgschools.org

STUDENT RECORDS

DESIGNATION OF DIRECTORY INFORMATION

During The school year, District staff members may compile non-confidential student directory

information specified below.

According to state and federal law, the below designated directory information may be publicly released

to educational, occupational or military recruiting representatives without your permission. If the

Governing Board permits the release of the below designated directory to persons or organizations who

inform students of educational or occupational opportunities, by law the District is required to provide the

same access on the same basis to official military recruiting representatives for the purpose of informing

students of educational and occupational opportunities available to them, unless you request in writing not

to release the student’s information without your prior written consent. If you do opt out of releasing any

and all of the below designated information, the District must provide military recruiters, upon request,

directory information containing the student’s names, addresses and telephone listings.

If you do not want any or all of the below designated information about your son/daughter to be released

to any person or organization without your prior written consent, you must notify the District in writing

by checking off any or all of the rejected information, signing the form at the bottom of this page and

returning it to the Principal’s office within two (2) weeks of receiving this form. If the School District

does not receive this notification from you within the prescribed time, it will be assumed that your

permission is given to release your son’s/daughter’s designated directory information.

I do not want the information I have marked below concerning

Student’s Name and Grade

designated as directory information and released to any person or organization without my prior written

consent:

Name Enrollment Status (i.e., part time or full time)

Address Grade Level

Email Address Dates of Attendance

Telephone Listing Honors and Awards Received

Date & Place of Birth Major Field of Study

Photograph

Most Recent Educational Agency or Institution Attended

Weight & Height of Members of Athletic Teams

Participation in Officially Recognized Activities and Sports

Parent/Guardian Signature Date

State of Arizona Department of Education

Office of English Language Acquisition Services

Primary Home Language Other Than English (PHLOTE)

Home Language Survey (Effective April 4, 2011)

These questions are in compliance with Arizona Administrative Code, R7-2-306(B)(1), (2)(a-c). Responses to these statements will be used to determine whether the student will be assessed for English Language Proficiency.

1. What is the primary language used in the home regardless of the language spoken by the student? __________________________________________________________

2. What is the language most often spoken by the student? _______________________

3. What is the language that the student first acquired? __________________________

Student Name ______________________________________ Student ID __________________ Date of Birth _____________________________________ SAIS ID ______________________ Parent/Guardian Signature __________________________________ Date _________________ District or Charter ______________________________________________________________ School _______________________________________________________________________ -------------------------------------------------------------------------------------------------------------------------------------------- Please provide a copy of the Home Language Survey to the ELL Coordinator/Main Contact on site. In SAIS, please indicate the student’s home or primary language.

1535 West Jefferson Street, Phoenix, Arizona 85007 • 602-542-0753 • www.azed.gov/oelas

Estado de Arizona Departamento de Educación

Servicios de Aprendizaje del Inglés

Idioma Principal en el Hogar excluyendo el inglés (PHLOTE) Encuesta sobre el Idioma en el Hogar

(Efectivo el 4 de abril de 2011)

Preguntas en conformidad con R7-2-306(B)(1), (2)(a-c) del Reglamento de la Junta Directiva.

Las respuestas que proporcione a las preguntas siguientes serán usadas para determinar si se evaluará la competencia en el idioma inglés de su hijo(a). 1. ¿Cuál idioma se habla principalmente en su hogar sin considerar el idioma que habla el

estudiante? ________________________________________________________________ 2. ¿Cuál idioma habla el estudiante con mayor frecuencia? __________________________ 3. ¿Cuál fue el primer idioma que aprendió el estudiante? ___________________________ Nombre del estudiante ___________________________ Núm. de identificación _____________ Fecha de nacimiento __________________________ Núm. de SAIS ______________________ Firma del padre o tutor ____________________________________ Fecha _________________ Distrito o Charter _______________________________________________________________ Escuela _______________________________________________________________________ -------------------------------------------------------------------------------------------------------------------------------------------- Please provide a copy of the Home Language Survey to the ELL Coordinator/Main Contact on site. In SAIS, please indicate the student’s home or primary language.

1535 West Jefferson Street, Phoenix, Arizona 85007 • 602-542-0753 • www.azed.gov/oelas

SPECIAL PROGRAM SERVICES INFORMATION SURVEY Parents or guardians of students should complete this form at time of enrollment:

In order to provide continuity in the educational environment, it is important that we are informed

of any special

education services previously received by your child. Please complete the following form and feel

free to add any

comments in the space provided below.

Student Name_____________________________________________________

First Middle Last

Previous School ___________________________________________________

Has your son/daughter ever had any Special Program Services provided for him/her at a

previous school?

____ Yes ____ No

Has your son/daughter ever been tested for Special Program Services while at a previous

school?

____ Yes ____ No

Have you ever signed an individualized Education Plan (IEP) that provides for Special

Program Services for your

son/daughter? ____ Yes ____ No

If yes, please indicate previous school and approximate date the most recent IEP was written

_______________________________________________________________

Has your son/daughter received any special program services in the past but is no longer in

need of these services

____ Yes ____ No

Please check the special programs that your student has participated in: ____ Gifted and honors classes

____ Specific learning disability (tutoring or resource room support)

____ Speech and language therapy

____ Multiple disabilities

____ Orthopedic impairment (Physical or Occupational Therapy or Adaptive PE)

_____ Other health impairment

____ Hearing impairment

____ Visual impairment

____ Emotional disability, self-contained classroom

____ Emotional disability, resource room support

____ Traumatic brain injury

____ Section 504 Accommodation Plan

____ English as Second Language Program/Bi-lingual resource)

____ Other or comments __________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

Signature of Parent ______________________________________Date

__________________

W I C K E N B U R G H I G H S C H O O L 1 0 9 0 S O U T H V U L T U R E M I N E R O A D • W I C K E N B U R G , A Z 8 5 3 9 0

( 9 2 8 ) 6 8 4 - 6 6 0 0 • ( 9 2 8 ) 6 8 4 - 6 6 2 8 F A X w w w . w i c k e n b u r g s c h o o l s . o r g

520 FORM INFORMATION

Dear Parents:

It has come to my attention that at time of your student’s enrollment you were not given a 520 form. This is for transfer students/athletes. It is very important to fill out a 520 form along with

the WHS Athletic Packet in order for your son/daughter to be considered eligible for their

current sport. This form is different than any enrollment form you were given. This is strictly

for sports.

Your student will be limited to practice only until the AIA receives the completed form from all

parties and we have reviewed it. If your student is cleared, they will be able to continue to play.

If they are not, then your student may not participate in any games for one year. This form is

required for all transfer students in order to determine eligibility to play sports. In other words,

the AIA is verifying you are not being recruited or violating any AIA bylaws.

Please fill out the 520 form online at www.aiaonline.org/520/. Once you are on the website,

press begin and then follow the steps and answer each question to the best of your knowledge.

After your portion is completed, the form is electronically transmitted to all parties involved.

Please does not delay for it may hinder your son’s/daughter’s sports eligibility and participation.

Once you have completed the form please advise me via email or telephone. Thank you for

your assistance in this matter and please do not hesitate to contact me if you have any questions.

Sincerely,

Casey E. Gipe Principals' Secretary Wickenburg High School "Home of the Wranglers" cgipe@wickenburg.k12.az.us 928-684-6621

W I C K E N B U R G H I G H S C H O O L

1 0 9 0 S O U T H V U L T U R E M I N E R O A D

W I C K E N B U R G , A Z 8 5 3 9 0

FACSIMILE TRANSMITTAL SHEET

TO: FROM:

Peggy Anliker

COMPANY: DATE:

FAX NUMBER: TOTAL NO. OF PAGES INCLUDING COVER:

PHONE NUMBER: SENDER’S FAX NUMBER:

928-684-6628

RE: REGISTRAR PHONE NUMBER:

928-684-6608

URGENT FOR REVIEW PLEASE COMMENT PLEASE REPLY PLEASE RECYCLE

NOTES/COMMENTS:

REQUEST FOR STUDENT RECORDS

Previous School

School Address

City State Zip

Student Name

Birth Date

The above student has enrolled at the Wickenburg High School. Please forward the following records to us at your earliest

convenience.

1. Official Transcript of grades and credits (mailed) Unofficial (faxed)

2. Withdrawal grades

3. Explanation of your grading system

4. Health and immunization records

5. Discipline records

6. Academic test scores

7. Arizona AIMS test results

8. IEP/Special Education Records

9. SAIS #

_________10. Birth Certificate

________11. ELL/AZELLA test scores

Thank you,

Peggy Anliker

Registrar

Parent/Guardian Signature

9 2 8 - 6 8 4 - 6 6 0 0 P H O N E / 9 2 8 - 6 8 4 - 6 6 2 8 F A X M A I N O F F I C E /