Moore Public Schools 2006-2007 Enrollment Form ID

Please bring the following items to your enrollment appointment. When Moore High has received all records MOORE"( Public Schools from the sending school, the parent will be contacted by a U:AtNiN"..;f-OP. urr counselor to set up an enrollment appointment. STUDENT ENROLLMENT CHECKLIST

Required Documents (missing documents will delay the enrollment process) □ Certified Birth Certificate

□ Two (2) Proofs of Residence in parent/guardian'sname (any two of the following): • Current month's utility bill: Water, gas, or electric only (within lhe last ··---·-· 30 days; entire bill or top portion showing name of service holder and service address required; water bill must be from the City of Moore or City of OKC; final notices and telephone/cable/internet bills will not be accepted).

• Current mortgage contracUmortgage statement/warrantydeed

• Ciirrent lease/rental contract ( each student's name must be listed on contract).

If the proof of residency is not in the parent/guardian's name, an affidavitis required.

□ ParenUGuardian Oklahoma Driver's License or Oklahoma State Photo ID with current address listed (Exceptions: Active Duty Military and Oklahoma Commercial Driver's Licenses). • The parent who is enrolling the student must be on the birth certificate. The guardian must show legal documents proving they have the right to enroll the student.

□ Academic History • • Withdrawal form from previous school (9th -12th only). • Unofficial transcript (9th-12th only). • · IEP or 504 documentation, if applicable.

□ Immunization Record Immunizations must be up to date prior to starting school.

Sta te D e Ja rt ment 0 f Ed ucat' 10n mmumza. r10n R ecuirement ��-�a..t-.;:,..-·-th··r.,_:.�..,,.,,:;ffi,�-t:ft'"� itm1{1��10:,tPre.':�R?:y:_:·_·��r�s:� •:.�.,K-1�,.6;�.,,.Gr� e,·.:.•: !?Lf!m!J1�1�IGra€(e:iTL::t(X:t%f2�!fGtad�Tt > .. >:" 40TaP 5 OTaP 5 DTaP 5DTaP 1 Tdap booster 3 IPB/OPV (polio) 4 IPB/OPV (polio) 4 IPB/OPV (polio) 4 IPB/OPV {polio) 1 MMR 2MMR 2MMR 2MMR 3 Hepatitis B 3 Hepatitis B 3 Hepatitis B 3 Hepatitis B 2 Hepatitis A 2 Hepatitis A 2 Hepatitis A 2 Hepatitis A 1 Varicella 1 Varicella 1 Varicella 1 Varicella *IMPORTANT!

1. You must first download a copy of the enrollment forms. The forms will not save unless downloaded to your device first.

2. Complete the downloaded forms and save again when finished. Email the saved forms directly to: [email protected] For Office Use Only Rev Jan- 2020 SCHOOL______1500 SE 4th Street 20____ - 20_____ Enrollment Form Moore, OK 73160 Grade______ID # ______Entry Date ______Student Information Grade ______Bus#______Affidavit ______Transfer ______Full name: ______Legal Last Name First Middle Birth Date: ______-______-______City & State of Birth:______Male_____Female_____ Is student on an IEP? Y_____N______Is student on a 504 plan? Y_____N______

Must check at least one or more of the following Races:

American Indian or Alaskan Native ___ Asian___ Black/African American____Native Hawaiian or Other Pacific Islander ___ Caucasian/White____ Is the Student Hispanic or Latino Culture or Origin? Y_____N_____

Country of Birth ______Date entered U.S. ____-____-______American Indian ancestry (regardless of degree) Y___N___Tribe ______(Eligible for Title VII program)

Resident Address: ______Hm Phone (_____) ______*Please include suffix (Ave, Dr, Pl, etc) and Apt # City State Zip

Mailing Address______*If different from resident address City State Zip

Parents(s)/ Legal Guardian(s) Living with Student (1) Parent / Guardian Name ______Relationship to Student ______Last First Middle Cell (____)______Work (____)______Email______@______Place Employed ______Located on Federal Property? Y___ N____ Active Military Y____N____

(2) Parent/Guardian Name/Step Parent______Relationship to Student______Last First Middle Cell(____)______Work(____)______Email______@______

Place Employed ______Located on Federal Property? Y____ N____ Active Military Y____N____

Are there any other children in the household attending Moore Public Schools? Y ____ N____ (1) ______Relationship to student ______School ______

(2) ______Relationship to student ______School ______

(3) ______Relationship to student ______School ______

Check One are natural parents Married _____ Divorced _____ Never Married _____ To secure your child’s safety, are current required court documents on file at the school? Y____N____ Legal custodian(s) ______Please list any additional Household members that are Military or Civilian working on federally owned Property:

Name:______Employer location/Address: ______Active Military Y____N____

Parent / Legal Guardian NOT living with student

Name ______Relationship to Student ______Last First Middle Address ______Home (____)______Cell (____)______Street City State Zip Work (____)______Email ______@______

Place Employed ______Located on Federal Property? Y____ N___ Military/Branch/Rank______

Non-Parent Emergency Contacts (Please list in order that they are to be contacted, persons listed below will be able to check students out) Name and relationship to student Home Cell Work

(1) ______-______(____)______(____) ______(____)______(2) ______-______(____)______(____)______(____)______(3) ______-______(____)______(____)______(____)______

Name of last school attended: ______City______State ______

Has student ever attended a Moore Public School ______Yes ______No Year Attended ______

Please check special programs that student has received: Gifted___ Lab_____Speech___OT / PT_____ Special Ed___ OK Promise___ Title I Reading___ Title IX___ JOM___ Other_____Health Care Management Plan______

Parent / Guardian Signature X ______Date _____-_____-______HOME LANGUAGE SURVEY FOR PRE-K-12 SCHOOL DISTRICTS 20____- 20____ ENCUESTA DEL IDIOMA HABLADO EN CASA–DISTRITOS ESCOLARES CON GRADOS PRE - K-12

STUDENT INFORMATION 20____- 20____ HOME LANGUAGE SURVEY FOR PRE-K-12 SCHOOL DISTRICTS 20____Name- 20____ of Student:HOME ______LANGUAGE SURVEY FOR PRE-K-12 SCHOOL DISTRICTStudentS ID #______Nombre del Estudiante Last Name / Apellido(s) FirstSTUDEN Name / PrimerT INFORMA Nombre TI O MiddleN Name / Segundo Nombre Identificación del Estudiante # STUDENT INFORMATION Gender: Male _____ Female _____ Date of Birth: ______STUDENT INFORMATI School:ON ______Sexo:NameMasculino of Student:Femenino ______Fecha de Nacimiento Escuela _ Student ID # ______Name of Student: ______Student ID # ______Name of Student: ______Last Name First Name Middle Name _ Student ID # ______Last Name First Name Middle Name Select one or more of theLa sfollowingt Name races: SeleccioneFirs unat Name o más de las siguientesMiddle razas:Name ______Gen Africander: Male American/Blac _____ Femk (Afroamericano/Negro) ale _____ Date of Birth: ______Caucasian/White (Blanco)_ School: ______Asian (Asiático)_____ Gender: Male _____ Female _____ Date of Birth: ______School: ______Gen Nativeder: M Hawaiian/Pacificale _____ Fem aleIslander ____ _ Date of Birth: ______American Indian/Alaskan_ Native School: ______Other (Otro) _____ Select one or more of the following races: Select(Nativo one de or Hawáimore ofo Islasthe following del Pacífico) races: (Indio Americano/Nativo de Alaska) S______elect o neAfrican or more American/Blac of the followingk races: ______American Indian/Alaskan Native ______Asian ______African American/Black ______American Indian/Alaskan Native ______Asian ______NativeAfrican HawAmerican/Blacaiian/Pacifick Islander ______Caucasian/WhiteAmerican Indian/Alaska n Native ______AsiaOthenr Is the______student Native of Hispanic Hawaiian/Pacific or Latino Islandeculture ror origin?___ Yes______Caucasian/White No: ______Other ¿El estudiante______Native es de origen Hawaiian/Pacific o cultura Hispana Islande o Latina?r ___Sí___ Caucasian/White ______Other Is the student of Hispanic or Latino culture or origin? Yes _____ No: _____ Is the student of Hispanic or Latino culture or origin? Yes _____ No: _____ 1. WhatIs the is studentthe primary of Hispanic language or Latinoused in cult theur home,e or origin? regardless Yes _____ of the language No: _____ spoken by the student? ______¿Cuál1. es el What lenguaje is the principal primary usado langu enage el hogar,used independientemente in the home, regardless del idioma of the que language habla el estudiante? spoken by the student? ______1. What is the primary language used in the home, regardless of the language spoken by the student? ______2. What1. is What the language is the prim mostary lanoftengu agespokenused by in the the student? home, regardless ______of the language spoken by the student? ______¿Cuál2. es elWhat lenguaje is the hablado languag cone mayormost ofrecuenciaften spoken por byel estudiante?the student ? ______2. What is the language most often spoken by the student? ______2. 3. What languageWhat is the did languag the studente most learn oft enfirst?spoken______by the student? ______3. What language did the student learn first? ______¿Qué3. idiomaWhat aprendió language primero did elthe estudiante? student learn first? ______3. What language did the student learn first? ______4. Does4. the Does parent/guardian the parent/gu arneeddian interpretation need interpretation services?services? Yes _____ Yes No______No If so,_____ what Iflanguage? so, what ______language? ______¿El padre4. / Does tutor necesitathe parent/gu serviciosardian de interpretación need interpretation? services?Sí Yes _____ NoSi contestó_____ sí,If so, ¿qué what idioma? language ? ______5. Does5. the Does parent/guardian the parent/gu arneeddian translated need translated materials?materials? Yes _____ Yes No______No If so,____ what_ Iflanguage? so, what ______language? ______5. Does the parent/guardian need translated materials? Yes _____ No _____ If so, what language? ______¿El padre5. / Does tutor necesitathe parent/gu serviciosardian de traducción need translated? materials?Sí Yes _____ NoSi ____contestó_ Ifsí, so, ¿qué what idioma? language ? ______

______Parent/Guardian Signature (Firma de los padres/Tutor) SCHOOL USE ONLY Date (Fecha) Please have test score documentationSCHOO availablLe U forSE the ONL RegiY onal Accreditation Officer to review. Please have test score documentation availablSCHOOLe for USEthe Regi ONLYonal Accreditation Officer to review. Please have test score documentation available for the Regional Accreditation Officer to review. ☐ Other language than English indicated two or more times on questions 1 – 3 above. The student is classified as MORE OFTEN and automatically qualifies as bilingual on ☐ Other language than English indicated two or more times on questions 1 – 3 above. The student is classified as MORE OFTEN and automatically qualifies as bilingual on ☐ Other languthe aagccereditatio than Enng relispoh rtind. icated two or more times on questions 1 – 3 above. The student is classified as MORE OFTEN and automatically qualifies as bilingual on the accreditation report. ☐ Other languthe aagccereditatio than Enng relispoh rtind. icated only once on questions 1 – 3 above. The student is classified as LESS OFTEN and only qualifies as bilingual on the accreditation ☐ Other language than English indicated only once on questions 1 – 3 above. The student is classified as LESS OFTEN and only qualifies as bilingual on the accreditation ☐ Other langureportag ife he tha onr sEheng lismeeth inds onicateed of onthely following once on: questions 1 – 3 above. The student is classified as LESS OFTEN and only qualifies as bilingual on the accreditation report if he or she meets one of the following: report if he or she meets one of the following: ☐ Scored 35% of below on norm-referenced test (NRT) on the composite reading score. ☐ Scored 35% of below on norm-referenced test (NRT) on the composite reading score. ☐ Scored 35limite% odf knowledbelow onge no orrm-referenc unsatisfactoredy tes ont R(NRTeadin) ogn Oklahom the composita Coree re Cuadrringicul scumore Tes. t (OCCTs). ☐ Scored limited knowledge or unsatisfactory on Reading Oklahoma Core Curriculum Test (OCCTs). ☐ ScoreDesignated limited Englisd knowledh Learnege orr onun satisfactorone of the yOklah on Roeamdina Egng Oklahomlish langua Coragee p Curoficienrriculcyum a Tesssesst (OCCTs)ments: AC. CESS for ELLs 2.0, Alternate ACCESS for ELLs, ☐ Designated English Learner on one of the Oklahoma English language proficiency assessments: ACCESS for ELLs 2.0, Alternate ACCESS for ELLs, ☐WIDDesignateA Screed Englisner, WIhDA Learne MODELr on o, nK-WAPTe of the ,Oklahom WAPT oar OklahEnglisomh lana Pre-guagKe Languag proficienecy Screenin assessmg enTootsl:. ACCESS for ELLs 2.0, Alternate ACCESS for ELLs, WIDA Screener, WIDA MODEL, K-WAPT, WAPT or Oklahoma Pre-K Language Screening Tool. WIDA Screener, WIDA MODEL, K-WAPT, WAPT or Oklahoma Pre-K Language Screening Tool. DOCUMENTATION OF A TEST RESULT FOR STUDENTS MARKED LESS OFTEN DOCUMENTATION OF A TEST RESULT FOR STUDENTS MARKED LESS OFTEN Date(s) Norm Reference Test (NRDOCUMENTATIONT) OF A TESTNam RESULTe of t heFOR NR STUDENTST MARKED LESSRe OFTENading Total Composite Score(s) % Date(s) Norm Reference Test (NRT) Name of the NRT Reading Total Composite Score(s) % Date(s) Norm Reference Test (NRT) Name of the NRT Reading Total Composite Score(s) %

Date(s) of Reading OCCT Score(s) on Reading OCCT Date of the Oklahoma Score on Pre-K Date(s) of Reading OCCT Score(s) on Reading OCCT Date of the Oklahoma Score on Pre-K Date(s) of Reading OCCT Limited Knowledge Score(s Unsatisfactor) on Readiny g OCCSatisfactorT y Advanced DatPre-eK o Lanf thegu Oklahomaage ScorLangue ageon Pre-K Limited Knowledge Unsatisfactory Satisfactory Advanced Pre-K Language Language Limited Knowledge Unsatisfactory Satisfactory Advanced Pre-ScreeninK Lang guTooagel LanScreeninguageg Tool Limited Knowledge Unsatisfactory Satisfactory Advanced Screening Tool Screening Tool Limited Knowledge Unsatisfactory Satisfactory Advanced Screening Tool Screening Tool Limited Knowledge Unsatisfactory Satisfactory Advanced Limited Knowledge Unsatisfactory Satisfactory Advanced Limited Knowledge Unsatisfactory Satisfactory Advanced Limited Knowledge Unsatisfactory Satisfactory Advanced Date(s) of ACCESS for ELLs 2.0 or Score(s) on ACCESS for Date(s) of WIDA Screener or Score(s) on WIDA Screener or Date(s) of ACCESS for ELLs 2.0 or Score(s) on ACCESS for Date(s) of WIDA Screener or Score(s) on WIDA Screener or Date(sAlternat) of ACeCES ACCES foSSr ELL Tess t2. 0 or Score(sELL) ons ACCE2.0 or SS for Date(sK-WAPT/WAP) of WIDA ScrTee oner r or Score(sK-WAPT/WAP) on WIDA ScreT oenr er or Alternate ACCESS Test ELLs 2.0 or K-WAPT/WAPT or K-WAPT/WAPT or Alternate ACCESS Test AlternatELLse 2.ACCESS0 or K-WAPT/WAPWIDA MODETL o r K-WAPT/WAPWIDA MODELT or Alternate ACCESS WIDA MODEL WIDA MODEL CompositeAlternate ACCESSLiteracy WIDA MODEL Composite WIDLiteracyA MODEL Score Composite Literacy Composite Literacy Score CompositeScore LiteracyScore CompositeScore Literacy Score Score Score Score 1. Score S2co. re S1co. re 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. White - Bilingual Count/Accreditation Yellow - Cumulative Folder Pink - ELL Folder MOORE PUBLIC SCHOOLS

LEGAL CUSTODY DOCUMENTS

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.

On your child’s most recent enrollment form, you indicated that:

a. _____ The parents are divorced. A copy of current court documents indicating the name of the custodial parent have been provided to the school.

b. _____ The student is living with a person other than a parent. Paperwork in the form of a court document or DHS custody orders indicating that this is a legal arrangement, have been provided to the school.

c. _____ Legal documents are not available. I understand the school will have to release my child to any parent, on request, without such documents.

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

e. _____ Parents are not divorced.

f. _____ Parents never married.

______Parent/Guardian – PLEASE PRINT Date

______Parent/Guardian Signature 2-27-12 Moore Public Schools Health Form This health and development form must be completed by the parent or guardian each school year. It is not a part of your student’s permanent record.

Student’s Name ______Birthdate ______Today’s Date ______

School Year ______Grade ______Teacher ______

Does your child take medication on a routine basis?  No  Yes

Medication ______Purpose ______At School  At home

Please contact the office at your child’s school regarding the Medication Policies. If your child must take prescription or over-the-counter medication during the school day, he or she must have a current Medication Consent form on file signed by a physician and a parent or guardian.

Check the box and explain if your child has a history of or currently has the following conditions or concerns. Asthma Mild Moderate Severe Heart Problems Rescue Inhaler Prescribed Congenital Heart Defect Please Explain ______Allergies Mild Moderate Severe ______EpiPen Prescribed Other ______Bees/Insects ______Latex Medication ______Seizures Reaction ______Febrile Seizures Foods Contact Ingestion Last Occurrence ______Please List ______Epilepsy/Seizure Disorder ______Last Occurrence ______Use Emergency Plan if Occurs at School Reaction ______Has Emergency Medication Prescribed ______Other ______Physical Limitations Special Equipment Needed at Home Diabetes Type 1 Type 2 Special Equipment Needed at School No Pump Please Explain ______Has Pump ______

ADD/ADHD Other Medication at Home Please Explain ______Medication at School ______

Do you give Moore Public Schools permission to screen your child? (Example: Vision/Hearing screenings) No Yes

My child DOES NOT have any health issues or concerns at this time.

I sign that the above is true and accurate to the best of my knowledge.

Parent/Guardian Signature ______Today’s Date ______

Revised 01/2017 OSIIS - Authorization to Use or Share Protected Health Information with School

Student Name ______Date of Birth ______

Oklahoma State Immunization Information System (OSIIS) is a statewide immunization registry operated by the Oklahoma State Department of Health, designed to collect and maintain accurate, complete, and current immunization records for Oklahomans of all ages. OSIIS began operations in 1994 and some clinics do not participate in OSIIS, therefore OSIIS does not contain the immunization records of all Oklahomans.

Moore Public Schools uses OSIIS to access student immunization records in compliance with Oklahoma state law regarding school requirements for vaccines. Parent permission is required for Moore Public Schools to access this information.

Choose One  I DO authorize the release my child’s records and information located within OSIIS to Moore Public Schools.  I DO NOT authorize the release my child’s records and information located within OSIIS to Moore Public Schools.

The information may be disclosed for the following purpose(s): To ensure the student meets Oklahoma eligibility requirements for schools/day cares as outlined in Title 70 O.S. § 1210.191 and Oklahoma Administrative Code ("OAC") 310:535-1-2 and OAC 310: 535-1-3

I understand that by voluntarily signing this authorization: • I authorize the use or disclosure of my PHI as described above for the purpose(s) listed. • I have the right to withdraw permission for the release of my information and revoke this authorization at any time in writing. • I have the right to receive a copy of this authorization. • I understand that unless the purpose of this authorization is to determine payment of a claim for benefits, signing this authorization will not affect my eligibility for benefits, treatment, enrollment, or payment of claims. • I understand I may change this authorization at any time in writing. However, I understand I cannot restrict information that may have already been shared based on this authorization. • Information used or disclosed pursuant to the authorization may be subject to redisclosure by the recipient and may no longer be protected by HIPAA Privacy Regulations.

______Signature Date

______Name (Print) Relationship to Student

01/2019 1500 SE 4th Street, Moore, OK 73160 (405) 735-4200

Student Name ______

Homeroom Teacher ______

Acknowledgment

Student Handbook □ I understand the expectations and procedures as outlined in the MPS Handbook that can be located online at www.mooreschools.com

I acknowledge that I have read these policies, procedures, guidelines and rules on www.mooreschools.com website

□ Family Educational Rights and Privacy Act (FERPA) □ Protection of Pupil Rights Amendment (PPRA) PPRA affords parents, students who are 18, or emancipated minors (“eligible students”) certain rights regarding our conduct of surveys, collection, and use of information for marketing purposes, and certain physical exams. □ Cell Phone Policy □ Meningococcal Meningitis

Acknowledged

Parent/Guardian Signature Date

Parent/Guardian Print Name

Student Signature Date Moore Public Schools 2020-21 Student Electronic Network Usage Policy Student Electronic Network Usage Policy

Carefully read this page, complete the information requested and sign.

______Student’s Name (Last, First) Grade Homeroom Teacher

As the parent or legal guardian of the above student, I hereby grant permission for my son or daughter to access the Internet through Moore Public Schools. I hereby acknowledge that I have read the Rules for Use of the Internet in their entirety, have discussed the rules with my son or daughter and recognize that violation of the rules can result in loss of access, disciplinary action, and possible legal action. I understand that some materials on the Internet may be objectionable, but I accept responsibility for guidance for the use of the Internet, setting and conveying standards for my son or daughter to follow when selecting, sharing or exploring information via the Internet.

______Student’s signature Date

______Parent’s signature Date

2020-21 RELEASE OF INFORMATION ‘OPT-OUT’

Please check your preference regarding Yearbook information and sign below:

 I DO NOT want to release my child’s name, phone number, or address for marketing purposes ie. yearbook/graduation services or photographers.

 I DO want to receive information about the school yearbook.

Name of Student (please print)______

Name of Parent/Guardian (please print)______

Signature______Date______Student Name______

2020-21 Moore Public Schools Release Form (Please sign and return to school)

Dear Parent/Guardian: As a part of Moore Public School’s (referred to as the “District”) promotion of school activities and recognition of student achievement, District staff members or members of the news media may photograph or film students while they are engaged in school activities not generally open to the public. District staff members or members of the news media may also photograph, film or display examples of your child or your child’s work. Because the District values your child’s privacy, your child’s last name will not appear in connection with any images of your child or any of your child’s work on the District’s Website.

I. Permission to Publish Student Work on the Internet

CHECK ONE (__) I, the undersigned, hereby authorize the District to display my child’s work on the Internet. I understand that my child’s last name and personal information will not be included. I understand that this work is accessible to anyone who is connected to the Internet and the ownership of intellectual property cannot be guaranteed. (__) I, the undersigned, DO NOT authorize any piece of my student’s work to be displayed on the Internet.

Name of Student (please print): ______

Student Signature:______Date: ______

Parent/Guardian Signature: ______Parent/Guardian Name (please print): ______

II. Permission to Release Student Image to News Media

CHECK ONE (__) I, the undersigned, authorize the release of my child’s image to the news media, as a part of his or her class work, or to publicize district activities not normally open to the public. An image could take the form of a photograph, video, or multimedia project. (__) I, the undersigned, DO NOT authorize the release of my child’s image to the news media.

Name of Student: ______Date: ______

Parent/Guardian Signature: ______Parent/Guardian Name (please print): ______

III. Permission to Publish Student Image on the Internet

CHECK ONE (__) I, the undersigned, hereby give permission for the District to publish my child’s image (photo) on the Internet. I understand that my child’s last name and personal information will not be included. I understand that this image will be accessible to anyone who is connected to the Internet. (__) I, the undersigned, DO NOT give permission for the District to publish my child’s image (photo) on the Internet.

Name of Student: ______Date: ______

Parent/Guardian Signature: ______Parent/Guardian Name (please print): ______PLEASE RETURN THIS FULL PAGE TO YOUR ADVISOR

COLLEGE, PROSPECTIVE COLLEGE AND MILITARY RECRUITMENT ACCESS TO STUDENT RECORDS FORM

TO PARENTS / GUARDIANS: Colleges and Military recruiters are provided access to student records under section 9528 of the Elementary and Secondary Education Act (No Child Left Behind). Records include student’s names, phone numbers, and home addresses. The law provides parents, guardians and students 18 or older the right to deny access to this information. If you DO NOT want your child’s name, phone number, and home address released, please complete and return the opt out form on the bottom half of this letter as soon as possible. School Administration

------2020-2021 COLLEGE/MILITARY RECRUITMENT OPT-OUT Please do not release my child’s name, phone number, or address to colleges, perspective colleges and military recruiters.

Student’s Name______

______Signature of Parent / Guardian or Student (18 years or older)

Date of Request______Important Information for Parents about the ACT® Test

The Oklahoma State Department of Education and ACT want to mi:)ke sure your child is ready for the next steps after high school. Your local district has selected the ACT as their nationally recognized high school assessment for English Language Arts and math. The administration will be at school, during the state school day testing window in April 2020. There is no cost to you for this administration. Below is information for parents to be aware of when your child participates in ACT school day testing, as well as a consent form to complete and return to the school. Use of Non-Test Information Before test day, your child will be asked to provide basic identifying information and information about their college and career interests. (Note: Social Security numberis not requested).

· Information Type Description Specific Field/Section

The following fields are required for ACT to generate and deliver your child's score report: Name (first, last, middle initial), date of birth, and mailing address.

The optional, non-test section collects additional information about your child's college and career interests, including high school course/grade information, student profile, and interest inventory. These sections are helpful for college and career planning. We encourage students to complete these optional sections so that they can receive college and career planning information in addition to the test scores on their score reports. If parental consent is given to participate in the free Educational OpportunityService (EOS) from ACT, you authorize ACT and third-party organizations to contact your child. The organizations receive this information:

• Name and mailing address • Gender, date of birth, racial/ethnicity background • High school and year of high school graduation • Email address • Intended college major and occupational choice • Information provided in the Student Profile Section, the ACT test score range

ACT follows industry standards for high levels of security to protect private and personally identifiable information. ACT only shares EOS data with accredited postsecondary educational institutions, financial aid and scholarship agencies, and other educational programs. All organizations that participate in EOS agree to contact your child only to share information about their educational, scholarship, and/or financial aid programs. Parent/Guardian Consent Schools may only permit students who have parental consent to answer optional non-test questions and to answer "Yes" to participatein EOS. If you choose not to give consent, these sections of your child's score report will be blank. This includes reportssent to their high school, and any colleges or universities . •

D YES, I give consent for my child to answer optional non-test questions and to participate in the Educational Opportunity Service.

D NO, I do not give consent for my child to answer optional non-test questions or to participatein the Educational Opportunity Service.

Student Name:------,------(Please print)

Parent/Guardian Signature: ______Date: ____ * L A T UR AM TH W LL R LAC UR ATUR P E SE YPE YO N E, IS I EP E YO SIGN E. Please ensure this signed form is locally archived and available for assessment monitoring purposes. OMB Number: 1810-0021 Expiration Date: 02/29/2020

U.S. Department of Education Office of Indian Education Washington, 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 INFORMATION

Name of the Child ______Date of Birth ______Grade ______(As shown on school enrollment records) Name of School ______

TRIBAL ENROLLMENT

Name of the individual with tribal 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 readily 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 STATEMENT

I verify that the information provided above is accurate.

Name Parent/Guardian ______Signature ______

Address ______City ______State ______Zip Code ______

Email Address ______Date ______OMB Number: 1810-0021 Expiration Date: 02/29/2020

INSTRUCTIONS FOR THE ED 506 FORM FOR APPLICANTS: PURPOSE: To comply with the requirements in 20 USC 7427(a), which provides that: “The Secretary shall require that, as part of an application for a grant under this subpart, each applicant shall maintain a file, with respect to each Indian child for whom the local educational agency provides a free public education, that contains a form that sets forth information establishing the status of the child as an Indian child eligible for assistance under this subpart, and that otherwise meets the requirements of subsection (b)”.

MAINTENANCE: A separate ED 506 form is required for each Indian child that was enrolled during the count period. A new ED 506 form does NOT have to be completed each year. All documentation must be maintained in a manner that allows the LEA to be able to discern, for any given year, which students were enrolled in the LEA’s school(s) and counted during the count period indicated in the application.

FOR PARENTS/GUARDIANS: DEFINITION: Indian means an individual who is (1) A member of an Indian tribe or band, as membership is defined by the Indian tribe or band, including any tribe or band terminated since 1940, and any tribe or band recognized by the State in which the tribe or band resides; (2) A descendant of a parent or grandparent who meets the requirements described in paragraph (1) of this definition; (3) Considered by the Secretary of the Interior to be an Indian for any purpose; (4) An Eskimo, Aleut, or other Alaska Native; or (5) A member of an organized Indian group that received a grant under the Indian Education Act of 1988 as it was in effect on October 19, 1994.

STUDENT INFORMATION: Write the name of the child, date of birth and school name and grade level.

TRIBAL ENROLLMENT INFORMATION: Write the name of the individual with the tribal membership. Only one name is needed for this section, even though multiple persons may have tribal membership. Select only one name: either the child, child’s parent or grandparent, for whom you can provide membership information.

Write the name of the tribe or band of Indians to which the child claims membership. The name does not need to be the official name as it appears exactly on the Department of Interior’s list of federally-recognized tribes, but the name must be recognizable and be of sufficient detail to permit verification of the eligibility of the tribe. Check only one box indicated whether it is a Federally Recognized, State Recognized, Terminated Tribe or Organized Indian Group. If Terminated Tribe or Organized Indian Group is elected, additional documentation is required and must be attached to this form. • Federally Recognized- an American Indian or Alaska Native tribal entity limited to those indigenous to the U.S. The Department of Interior maintains a list of federally-recognized tribes, which OIE can provide you upon request. • State Recognized- an American Indian or Alaska Native tribal entity that has recognized status by a State. The U.S. Department of Education does not maintain a master list. It is recommended that you use official state websites only. • Terminated Tribe-a tribal entity that once had a federally recognized status from the United States Department of Interior and had that designation terminated. • Organized Indian Group- 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.

Write the enrollment number establishing the membership of the child, if readily available, or other evidence of membership. If the child is not a member of the tribe and the child’s eligibility is through a parent or grandparent, either write the enrollment number of the parent or grandparent, or provide other proof of membership. Some examples of other proof of membership may include: affidavit from tribe, CDIB card or birth certificate. Write the name and address of the organization that maintains updated and accurate membership data for such tribe or band of Indians.

ATTESTATION STATEMENT: Provide the name, address and email of the parent or guardian of the child. The signature of the parent or guardian of the child verifies the accuracy of the information supplied.

The Department of Education will safeguard personal privacy in its collection, maintenance, use and dissemination of information about individuals and make such information available to the individual in accordance with the requirements of the Privacy Act.

PAPERWORK BURDEN STATEMENT According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1810-0021. The time required to complete this portion of the information collection per type of respondent is estimated to average: 15 minutes per Indian student certification (ED 506) form; including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4651. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Office of Indian Education, U.S. Department of Education, 400 Maryland Avenue, S.W., LBJ/Room 3W203, Washington, D.C. 20202-6335. OMB Number: 1810-0021 Expiration Date: 02/29/2020. MOORE�r Public Schools LEARNING FOR LIFE MOORE HIGH SCHOOL 300 N. Eastern, Moore OK 73160 PHONE: (405) 735-4700 COUNSELING CENTER FAX: (405) 735-4783

REQUEST TO RELEASEEDUCATION RECORDS

To: Pleasesend Records To: (Lastschool attended: school district,school name and address)

ATTN: Registrar and Special Education Department at receivingschool:

Please fax, and then mail official copies of the following information for the student's listed below:

1. Transcript of all work completed including creditsto date 2. BirthCertificate 3. Immunizationand health records

4. Withdrawal gradeswith percentages of subjects in progress

th 5. Alltest scores including EOI, PLAN, CRT, ITBS, Explore, and 8 grade testing

6. All specialeducation records (to include Eligibility Statement, IEP)

7. All Gifted Education Records

8. Gradmg scaleifnume�cal scaleis used.

9. Other information ------

(Student's full name) (DOB) (Current Grade)

Federal Law (34 CFR § 99 .31 ): In accordance with FERPA, parental permission is no longer required when records are sentto another educational agency. FORMS ARE COMPLETED, WHAT DO I DO NEXT? You may want to print these two pages for personal use.

CLICK FILE AND SAVE. EMAIL SAVED COPY TO: @mooreschools.com

***After requestednandavis materials have been sent from the previous school, a counselor will call to make an appointment to enroll the student. (It could take up to two weeks to get paperwork from a previous school.)

What you can expect at the appointment. • Only the student and one parent may attend for safety purposes. • Documents that must be brought to the appointment. These documents include: Ø Certified Birth Certificate Ø Two (2) Proofs of Residence in parent/guardians name (any two of the following):

1. Current month’s utility bill, water, gas or electric only (within the last 30 days; entire bill or top portion showing name of service holder and service address required; water bill must be from the City of Moore or the City of Oklahoma City; final notices and telephone/cable/internet bills will not be accepted.

2. Current mortgage contract/mortgage statement/warranty deed. 3. Current lease/rental contract (each student’s name must be listed on the contract.

If the proof of residency is not in the parent/guardian’s name, an affidavit is required.

Other required documents to enroll: Parent/Guardian Oklahoma Driver’s License or Oklahoma State Photo ID with current address listed (Exceptions: Active Duty Military and Oklahoma Commercial Driver’s Licenses).

The parent who is enrolling the student must be on the birth certificate. The guardian must show legal documents proving they have the right to enroll the student.

Academic History Ø Withdrawal form from previous school. Ø Unofficial transcript Ø IEP or 504 documentation, if applicable. Moore High will send for these documents. Immunization Record: Immunizations must be up to date prior to starting school.

State Department of Education Immunization Requirement Pre-K Kdg-6th Grade 7th-11th Grade 12th Grade 4 DTaP 5DTap 5Dtap 5 Dtap 1 Tdap booster 3 IPB/OPV (polio) 4 IPB/OPV (polio) 4 IPB/OPV (polio) 4 IPB/OPV (polio) 1 MMR 2 MMR 2MMR 2 MMR 3 Hepatitis B 3 Hepatitis B 3 Hepatitis B 3 Hepatitis B 2 Hepatitis A 2 Hepatitis A 2 Hepatitis A 2 Hepatitis A 1 Varicella 1 Varicella 1 Varicella 1 Varicella