Millennium Community School Enrollment Application

State Testing mad Compulsory attendance Notification to Parents

Millennium Community School is a community school established under Chapter 3314 of the Ohio Revised

We are a public school, students enrolled are required to take Proficiency Tests and other examinations prescribed by law. In addition, there may be other requirements for students at the school that are prescribed by law.

Students who have been excused from compulsory attending law for the purpose of home education as defined by the Administrative Code shall no longer be excused for that purpose upon their enrollment in a community

To see a copy of Millennium's previous years state test results please visit the Ohio Department of Education website or obtain a copy from the school's main office.

For more information about this matter, please contact the school at (614) 255-5585 or the Ohio Department of Education

REQUEST FOR RELEASE OF STUDENT RECORDS

(For Entering Kindergarten's Only, Put N/A or Zeros If Not Appicable )
Previous School Name
Previous School Address

Street Address

CityState

Zip Code
Previous School's Phone
Previous School's Fax
Student's Legal Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Date
Upcoming Grade Level
Enrollment Date

MonthDayYear
1st day of school 08/20/2024
The records to be release should include:
- Discipline Records/Report
- All Report Card/Progress Reports
- Results of all standardized tests (OAA) and evaluations
- Results of all Cognitive Abilities tests and evaluations
- Results of all criterion-referenced tests and evaluations
- Current Health Card/Shot Records
- All Student Study Team (SST) evaluations and recommendations
- All Special Education Records including current ETR evaluations and Individual Education Program (IEP)
- Third Grade Guarantee Results
Parent/Guardian Signature

Clear

Former School Information
School District of Residence
eg. Columbus, Groveport, Whitehall, etc.
Former School Information (other than pre-school):

Public SchoolCharter SchoolHome SchoolNonpublic
Name of Former School
Address of Former School
Previous Grade
Withdrawal Date from Former School

MonthDayYear
Was your child suspended, expelled (forced to withdraw), or under discipline at the previous school attended?*

YesNo
If yes, please explain?

Information Verification
Due to the Missing Child Law (O.R.C. Sec. 3313.672), a copy of every student's birth certificate or other acceptable substitute must be on file. If documentation is not presented within 14 days of enrollment we are required by law to noti- fy our local law enforcement agency. This is for the protection of your child. If this student is court placed into the care of a legal guardian, a copy of the court document must accompany this enrollment application and is good for only one (1) school year or the terms of the court papers or if address changes, whichever comes first. If a divorce situation exists, certified full copy of the order or decree is required. Only court ordered custody documents are accepted.

I certify that the above stated information is correct and further understand that parts of it will be used to retrieve a State Wide Identification Number required by House Bill 282 for my student.

I state that the information provided is true and correct. I am aware that the Millennium Community School may use any legal means to verify my residence. I understand that falsification of information may be cause for immediate withdrawal of my student from the Millennium Community School and subject me to applicable criminal and civil penalties.
Signature of Parent/Legal Guardian*

Clear

Student Health History/Current Health Information

Important information obtained from this health history will be included on a confidential health condition list, if appropriate.
Students Name
Date of Birth

MonthDayYear
Date
Students Grade
Address

Street Address

Street Address Line 2

CityState

Zip Code
Allergies - Please list and describe allergies or reactions to:
Recommended treatment for allergy:
Health Conditions - Please list all health condition for student
Medication - Please indicate
Medication: If your child requires medication at school, then all medication sent to the school must be in the prescription container with a current date and an "Authorization for Administration of Medication" form must be on file (obtain from the school)
Signature*

Clear

Emergency Instructions
I give permission to Millennium Community School to secure emergency medical and /or surgical treatment for the above-named minor child while in its careI do not give permission to Millennium Community School to secure emergency medical and/or surgical treatment for the above-named minor child while in its care
Physician's Name
Phone
Physician's Address

Street Address Line 2

CityState / Province

Zip
Signature*

Clear

Uploading Required Documents For Enrollment

Upload all applied documents with named seciton
Birth Certificate*

Cancelof
Social Security Card*

Cancelof
Immunization Records*

Cancelof
Valid Parent/Guardian State ID*

Cancelof
Current Original Lease Agreement, Deed, or Mortgage Statement (If you are not leaseholder of your residence, you must submit a Residency Affidavit)*

Cancelof
One of the following (dated within 30 days of July): utility bill (gas, electric or water), paycheck stub, bank statement, Ohio Human Services, Social Security Paperwork*

Cancelof
Student's Most Recent Report Card

Cancelof
For entering 4th graders, Third Grade Guarantee results, student will be placed in 3rd grade until proof of promotion

Cancelof
Proof of TB test for any student who was born or lived outside the United States (if applicable)

Cancelof
Should be Empty:

Millennium Community School Enrollment Packet