K-6th Grade - Austin Enrollment Forms

Texas Education Agency Texas Public School Student Ethnicity and Race Data Questionnaire
The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff. This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC School district staff and parents or guardians of students enrolling in school are requested to provide this information. If you decline to provide this information, please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting. Please answer both parts of the following questions on the student’s or staff member’s ethnicity and race. United States Federal Register (71 FR 44866)
Part 1. Ethnicity: Is the person Hispanic/Latino? (Choose only one)*

Hispanic/Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.Not Hispanic/Latino
Part 2. Race: What is the person’s race? (Choose one or more)*

American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America), and who maintains a tribal affiliation or community attachment.Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.Black or African American - A person having origins in any of the black racial groups of Africa.Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.White - A person having origin in any of the original peoples of Europe, the Middle East, or North Africa.
Child's Full Name*

First NameLast Name
Signature*

Clear

HOME LANGUAGE SURVEY
19 TAC Chapter 89, Subchapter BB, §89.1215
(Home Language Survey only administered during initial enrollment in Texas public schools)

To be completed by Parent or Guardian for students enrolling in Prekindergarten*through grade 8 (or by students in grades 9-12).
* Prekindergarten includes any student enrolling in a 3- or 4-year-old school program.

Part One:
The state of Texas requires that the following information be completed for each student who enrolls in a Texas public school for the first time. It is the responsibility of the parent or guardian, not the school, to provide the language information requested by the questions below.

Dear Parent or Guardian:
Please answer the questions below about the languages your child or family uses. If your responses indicate the use of a language other than English, the school will conduct a language proficiency assessment to determine how well your child communicates in English. This information will be used to determine any appropriate linguistic supports and inform instructional recommendations. If you have questions about the purpose and use of the Home Language Survey, or you would like assistance in completing the form, please contact your school/district personnel.
This survey shall be kept in each student’s permanent record folder. A copy of this survey shall follow the student while enrolled in any public or open enrolled charter school in Texas.
Student Name:*

First NameLast Name
District Name:
Texas Preparatory School
Campus Name:

Part Two:

Please answer the questions to the best of your ability.
1. Which languages are used at home?
2. Which languages are used by the child at home?
3. If the child had a previous home setting, which languages were used? If there was no previous home setting, answer Not Applicable (N/A).
By Checking this box (below), I understand a request to correct an error to this Home Language Survey can only happen if: 1. My Child has not yet been assessed for English proficiency; and 2. Corrections are made within two calendar weeks of my child's enrollment date.*
Note: Please contact your school about the benefits of bilingual education services. The following resources may also provide information on program services that foster bilingualism.
- Parent/ Guardian Rights
- Bilingual Education Program
- Program Information Videos
Please visit the Emergent Bilingual Support Portal (txel.org) for additional information.
Signature

Clear
Date

MonthDayYear
Date

District Media Release Form
Select one*

YES, I do grant permission for pictures, videotapes, or other images of my son/daughter to be released to local newspaper, television, or other media such as school district web pages, newsletters, or pamphlets for the purpose of student and/or program recognition.NO, I do not grant permission for pictures, videotapes, or other images of my son/daughter to be release to local newspaper, television, or other media such as school district web pages, newsletters, or pamphlets for the purpose of students and/or program recognition.
Student Name

First NameLast Name
Grade Level
Parent/Guardian Signature

Clear
Today's Date

MonthDayYear
Date

REQUEST FOR RECORDS

Purpose of Disclosure: To determine appropriate placement and eligibility at Texas Preparatory School.
Student Name

First NameLast Name
DOB

MonthDayYear
Date
Social Security Number:
Grade Level
Name of Previous School:*
Phone Number

Area CodePhone Number
Fax

Area CodePhone Number
ATTENTION: REGISTRAR, PLEASE SEND THE FOLLOWING INFORMATION FOR THIS STUDENT

Withdrawal FormGradesImmunization RecordsCopy of Social Security Card or TSDS Unique IDCopy of Birth CertificateAttendance RecordsSTAAR Results and/or Standardized ScoresSpecial Education504 Program
Parent/Guardian

Clear

Socioeconomic Information

Texas Preparatory School is required to collect and report the socioeconomic status of each student to the Texas Education Agency (TEA) for purposes of the annual state accountability ratings and for federal reporting. Please note that this form is not sent to TEA and that the income levels indicated for your family are not reported to TEA. Only the Economic Disadvantaged status of each student as determined by the information provided is reported to TEA.
Student Name

First NameLast Name
Grade Level
DOB

MonthDayYear
Date
Do you receive Supplemental Nutrition Assistance (SNAP)?*

YesNo
If yes, what is your SNAP number?
Do you receive Temporary Assistance to Needy Families (TANF)?*

YesNo
If yes, what is your TANF number?
How many members are in the household (include ALL adults and children)?*

TOTAL MONTHLY HOUSEHOLD INCOME- Report income for all members of household excluding foster children. If you have reported a SNAP or TANF number above, you do not need to complete this section.*

	Income
1. Gross Monthly Earnings: Wages, Salary, Commissions
2. Monthly Welfare Payments, Child Support, Alimony
3. Monthly Payments from Pension, Retirement, Social Security
4. Monthly Dividends or Interest on Savings
5. Monthly Worker's Compensations, Unemployment
6. Other Monthly Income (SSI, VA, Disability, Farm etc.)
Total Monthly Household Income (Add lines 1-6)

In accordance with the provisions of the Protection of Pupil Rights Amendment (PPRA) no student shall be required, as part of any program funded in whole or in part by the U.S. Department of Education, to submit to a survey, analysis, or evaluation that reveals information concerning income (other than that required by law to determine eligibility for participation in a program or for receiving financial assistance under such program, without the prior written consent of the parent or leagal guardian.)
Please check one of the following two spaces as appropriate.*

I certify that all the information on this form is true and that all income is reported. I understand the school will receive federal funds and will be rated for accountability based on the information I proved.I choose not to provide this information. I understand that the school's disbursement of federal funds and accountability may be affected by my choice.
Parent/Guardian Signature*

Clear
Today's Date

MonthDayYear
Date

Immunization Records - must include student full name, DOB, vaccines received, clinic stamp and authorized signature from clinic on clinic letterhead
Social Security Card
Birth Certificate - State Certified (Hospital Form Not Accepted)
Signature

Clear

Student Residency Questionnaire

This questionnaire is intended to address the McKinney-Vento Homeless Education Act (42 U.S.C. 11435). The answers to this residency information help determine the services the student may be eligible to receive.
How did you hear about us?
1. Is your current address a temporary living arrangement?*

YesNo
2. Is this temporary living arrangement due to a loss of housing or economic hardship?*

YesNo
If you answered YES to the above questions, please complete the next question. If you answered No, you may stop here.
Where is the student presently living?

In a hotel/motelIn a shelterWith more than one family in a house or apartmentMoving from place to placeIn a place not designated for ordinary sleeping accommodations such as a car, park or campsite
Student Name

First NameLast Name
Parent/Legal Guardian

First NameLast Name
Parent/Guardian Signature

Clear
Today's Date

MonthDayYear
Date
Presenting a false record or falsifying records is an offense under section 37.10, Penal Code, and enrollment of the child under false documents subjects the person to liability for tuition or other costs, secion 25.002(3d), Texas Education Code.
Should be Empty:

K-6th Grade Austin Registration Form

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACT INFORMATION (if parents cannot be reached)

MEDICAL PROVIDER INFORMATION

ALLERGIES

TRANSPORTATION INFORMATION

Texas Education Agency Texas Public School Student Ethnicity and Race Data Questionnaire

District Media Release Form

REQUEST FOR RECORDS

Special Programs Survey Form

Socioeconomic Information

Student Residency Questionnaire