SY 2024-25 Enrollment Forms-English

PPEP TEC HIGH SCHOOL

Enrollment Forms SY 2024-25
SELECT A PPEP TEC HIGH SCHOOL LOCATION*
STUDENTS NAME*
NAME OF PREVIOUS SCHOOL ATTENDED
Name of the PPPE TEC High School
LIST OF REQUIRED DOCUMENTS
THE FOLLOWING DOCUMENTS MUST BE SUBMITTED FOR ENROLLMENT IN PPEP TEC HIGH SCHOOL
[] ALL DOCUMENTS IN THIS ENROLLMENT PACKET MUST BE COMPLETED AND SIGNED BY PARENT/GUARDIAN/STUDENT AND SCHOOL OFFICIAL WHERE NOTED

[] BIRTH CERTIFICATE, PASSPORT BAPTISMAL CERTIFICATE, OR ANY OTHER LEGAL DOCUMENT SHOWING LOCATION OF BIRTH AND NAME OF PARENT(S)

[ ] IMMUNIZATION RECORDS/EXEMPTION DOCUMENTATION-VERIFIED BY A MEDICAL OFFICIAL-THESE DOCUMENTS ARE REQUIRED To ATTEND SCHOOL BUT ARE NOT A REQUIREMENT

[] PROOF OF RESIDENCY: UTILITY BILL, COPY OF LEASE, NOTARIZED LETTER BY HOMEOWNER GOVERNMENT ISSUED ID CARD, PROPERTY TAX BILL, BANK OR CREDIT CARD STATEMENT. PAYROLL STUB, CERTIFICATE OF TRIBAL ENROLLMENT. DOCUMENT FROM A STATE OR FEDERAL GOVERNMENT AGENCY

[] WITHDRAWAL FORM: FROM PREVIOUS HIGH SCHOOL This Document Is A Requirement To Attend School, But Is Not A Requirement For Enrollment

[] OFFICIAL TRANSCRIPTS-CERTIFIED "OFFICIAL" IN A SEALED ENVELOPE FROM PREVIOUS SCHOOL

[] SPECIAL EDUCATION RECORDS-FROM PREVIOUS SCHOOL ATTENDED (IF APPLICABLE)
Birth Certificate-Proof of Birth

Cancelof
Immunization Records

Cancelof
Proof of Address

Cancelof
Withdrawal Form from Previous School

Cancelof
Official Transcript-Certified Official

Cancelof
Special Education Records or Other School Documents

Cancelof
NAME OF PARENT/GUARDIAN SUBMITTING ENROLLMENT OR STUDENT*
DATE*

MonthDayYear
Date
(PHONE NUMBER)
*Students must be between the ages of 14-21 and have an gth grade diploma to be considered for enrollment
HOW DID YOU HEAR ABOUT US?*
PPEP TEC HIGH SCHOOL
STUDENT ENROLLMENT FORM
SELECT A PPEP TEC HIGH SCHOOL LOCATION*
STUDENT INFORMATION
Name*

STUDENTS FIRST NAMESTUDENTS LAST NAME
DATE OF BIRTH*

MonthDayYear
Date
Address

STREET ADDRESS

Street Address Line 2

CITYSTATE

ZIP CODE
MAILING ADDRESS (IF DIFFERENT FROM ABOVE)
Address

MAILING ADDRESS IF DIFFERENT FROM ABOVE

Street Address Line 2

CITYState / Province

ZIP CODE
CELL PHONE
WORK PHONE
EMAIL ADDRESS
example@example.com
GENDER

MaleFemale
ETHNICITY

American Indian/Alaskan NatimeBlackHispanicWhiteAsian/Pacific Islander
Has the Student ever been Enrolled in a Special Education Program?

YesNo
Is the Student a Dependent of a Full Time ACTIVE DUTY Member of the Armed Forces?

ArmyNavyAir ForceMarine CorpsCoast GuardNational Guard
Start Date

MonthDayYear
Date
END DATE

MonthDayYear
Date
*Please note: PPEP TEC is committed to providing the best educational opportunity to every student. We ask for the above information in order to ensure continuity of services, in keeping with that commitment.

I THE UNDERSIGNED HEREBY CERTIFY THAT, TO THE BEST OF MY KNOWLEDGE AND BELIEF, THE ANSWERS TO THE FOREGOING QUESTIONS AND APPLICATION ARE COMPLETE AND ACCURATE.
PARENT/GUARDIAN OR STUDENT'S SIGNATURE

Clear
DATE

MonthDayYear
Date
PARENT/GUARDIAN INFORMATION
WITH WHOM DOES THE CHILD CURRENTLY LIVE?

MotherFatherSelfFosterParent/Group HomeOther
NAME
Address

STREET ADDRESS

Street Address Line 2

CITYSTATE

Zip CODE
CELL PHONE
WORK PHONE
EMAIL
example@example.com
In What Language Do You Prefer To Receive Written Communication
In What Language Do You Prefer To Speak
EMERGENCY CONTACT INFORMATION
NAME
RELATIONSHIP
CELL PHONE
WORK PHONE
HEALTHCARE INFORMATION
ALLERGIES
MEDICATIONS
SPECIAL MEDICAL CONDITIONS
SERIOUS ILLNESSES OR DISABILITIES SPECIFY
DIETARY CONCERNSRESTRICTIONS
I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE AND ACCURATE
PARENTGUARDIAN ADULT STUDENT SIGNATURE

Clear
DATE

MonthDayYear
Date
ARIZONA DEPARTMENT OF EDUCATION

OFFICE OF ENGLISH LANGUAGE ACQUISITION SERVICES
The responses to this Home Language Survey (HLS) are used by the school to provide the most appropriate instructional programs and services for the student. The answers below will determine if a student will take the Arizona English Language Learner Assessment (AZELLA). Please respond to each of the three questions as accurately as possible. If you need to correct any of your responses, this must be done before the student takes the AZELLA Placement Test.
1 What language do people speak in the home most of the time
2 What language does the student speak most of the time
3 What language did the student first speak or understand
Student Name
District Student ID
Date of Birth

MonthDayYear
Date
SSID
ParentGuardian Signature

Clear
Date

MonthDayYear
Date
District or Charter-PPEP TEC High School
Select your PPEP TEC High School Campus
Arizona Department of Education

Arizona Residency Documentation Form
Student's Name

First NameLast Name
School Campus
School District or Charter Holder (PPEP TEC High School)
Name of Parent/Guardian

First NameLast Name
As the Parent/Legal Guardian of the Student, I attest* that I am a resident of the State of Arizona and submit in support of this attestation a copy of the following document that displays my name and residential address or physical description of the property where the student resides:
Select all of the documents that have been provided upon registration/enrollment

Valid Arizona driver's license, Arizona identification card or motor vehicle registrationValid Arizona Address Confidentiality Program authorization cardReal estate deed or mortgage documentsProperty tax bill
Select all of the documents that have been provided upon registration/enrollment

Residential lease or rental agreementWater, electric, gas, cable, or phone billBank or credit card statementW-2 wage statement
Select all of the documents that have been provided upon registration/enrollment

Payroll stubCertificate of tribal enrollment (506)) form) or other identification issued by a recognized Indian tribe in ArizonaDocumentation from a state, tribal or federal government agency (Social Security Administration, Veteran's Administration, Arizona Department of Economic Security)Temporary on-base billeting facility (for military families)
Select all of the documents that have been provided upon registration/enrollment

Consular identification card issued by a foreign government as a valid form of identification if the government uses biometric verification techniques in issuing the consular identification cardI am currently unable to provide any of the foregoing documents. Therefore, I have provided an original affidavit signed and notarized by an Arizona resident who attests that I have established residence in Arizona with the person signing the affidavit,
Signature of parent/guardian

Clear
Date

MonthDayYear
Date
State of Arizona

Affidavit of Shared Residence
Student Name

First NameLast Name
Parent/Legal Guardian Name

First NameLast Name
School Name
School District or Charter Holder (PPEP TEC High School)
Name of the Arizona Resident

First NameLast Name
I, (resident name) blanks swear or affirm that I am a resident of the State of Arizona and that the present persons listed below reside with me at my residence, described as follows:
Persons who reside with me:
My aAddress

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I submit in support of this attestation a copy of the following document that displays my name and current residence address of my physical description of my property.
Select all documents provided for this document

Arizona driver's license, Arizona identification card or motor vehicle registrationArizona Address Confidentially Program authorization cardReal estate deed or mortgage documentsProperty tax bill
Select all documents provided for this document

Residential lease or rental agreementWater, electric, gas, cable, or phone billBank or credit card statementW-2 Credit card statement
Select all documents provided for this document

Payroll stubCertificate of tribal enrollment (506 Form) or other identification issued by a recognized Indian tribe in ArizonaDocumentation from a state, tribal government agency (Social Security Administration, Veteran's Administration, Arizona Department of Economic Security)Consular identification card issued by a foreign government as a valid form of identification if the consular government uses biometric verification techniques in issuing the consular identification card
The remainder of this form must be completed by a licensed Notary Public.
Signature

Clear
Please provide a copy of the Home Language Survey to the EL Coordinator/Main Contact on site. In AzEDS, please enter all three HLS responses.

These HLS questions are in compliance with Arizona Administrative Code (R7-2-306(B1),(2a-c (Revised 05-2023)

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

McKinney-Vento Program
STUDENT RESIDENCY QUESTIONNAIRE

Section A
Information contained on this form is confidential and used to determine whether a child or youth meets the definition of homeless under the McKinney-Vento Act. The Education for Homeless Children and Youth (EHCY) program as authorized under Title VII-B of the McKinney-Vento Homeless Assistance Act (42 U.S.C. 11431 et seq. Please note, false claims about living situations may affect enrollment.
Todays date*

MonthDayYear
Date
Name of individual completing this form*
Your telephone number
Your email address
example@example.com
Student's Name*
Last school attended
Current grade*
Birth date*

MonthDayYear
Date
Do you have additional children attending school in our district?

YesNo
Do you have children of the preschool age?

YesNo
Please provide information about additional children attending school in our district or of preschool age. (Last Name, First Name, Grade, School, District)
Address of where the student slept last night*
Is this address based on a temporary living arrangement? (Examples: hotel; shelter; transitional housing; sharing the housing of others due to loss of housing, economic hardship, or similar reason; car; park; campsite. In a home that does not have running water, electricity, bathroom, proper place to sleep, heating/cooling)*

YesNo
NOTE: If you checked "No" to the temporary living arrangement, you may STOP here. If you checked "Yes", please continue to Section B.
STUDENT RESIDENCY QUESTIONNAIRE

Section B
Name of the parent/guardian/adult caring for the student
Relationship to the student
If the address you provided in section A is based on a temporary living arrangement, is it due to loss of housing or economic hardship, or you have no place to stay?

YesNo
In a place that does not have windows, doors, running water, heat, or electricity, or is overcrowded.

Yes
Staying with friends, or relatives because of loss of housing, economic hardship, or similar reasons, (For example: eviction, foreclosure, fire, flood, lost job, divorce, domestic violence, kicked out by parents, ran away from home)

Yes
What date did you begin staying here?

MonthDayYear
Date
In a shelter/transitional housing program

Yes
Name of the agency providing the assistance
What date did you begin staying here?

MonthDayYear
Date
In an unsheltered location (i.e. tent, vehicle, abandoned building, streets, campground, park, bus/train station, or similar place)

Yes
Provide the main cross streets of this unsheltered location
Staying in a hotel/motel

Yes
The name of the hotel/motel and address if possible
What date did you begin staying here

MonthDayYear
Date
With an adult who is not a parent or court-appointed legal guardian

Yes
Alone, not in the care of a parent or court-appointed legal guardian

Yes
None of the above (Please explain:)
The following signature certifies that the information provided above is accurate. False claims about living situations may affect enrollment.
Signature of Person Providing Information: Parent/Legal Guardian/Caregiver/Student

Clear
Date

MonthDayYear
Date
CAREGIVER'S AUTHORIZATION AFFIDAVIT

This form is not a legal document and is solely for school contact only
The information on this form is required to meet the Education for Homeless Children and Youth (EHCY) program, authorized under Title VII-B of the McKinney-Vento Homeless Assistance Act (42 U.S.C. 11431 et seq.) There are situations when a child or youth who is homeless may not be able to reside with their parent or guardian; however, this fact does not nullify the child's or youth's right to receive a free, appropriate public education.

In this situation, the child may be considered an unaccompanied youth. The term unaccompanied youth includes a youth not in the physical custody of a parent or guardian. [42 U.S.C. 11434A(6)] The adult "caregiver" requesting enrollment for a minor student shall complete this form. The caregiver is defined at the adult presenting him/herself for enrollment and educational services while not in the physical custody of a parent or legal guardian. By signing below, I acknowledge the following:
- I am 18 years of age or older and have agreed to fulfill the role of caregiver for the minor student named below, who is unaccompanied by a parent or legal guardian.
- I agree to make a good faith effort to encourage the minor student named below to attend school.
- I will attempt to contact the school office if I become aware that the minor student named below will not be attending school on that day(s) and share whether the absence is with or without my approval.
- I have provided the school district with proof of my residence and personal identification.
- I understand that signing this document does not make me the legal guardian of the minor student listed below or make me financially responsible for the minor student, even if I am providing financial support to the student.
- I understand that I may choose to make educational decisions on behalf of the minor and in all other ways stand in for the authorizing party with respect to federal, state and district educational policy, including, but not limited to, accessing the minor's educational records, representing the minor in enrollment, disciplinary, curricular, special education or other matters, signing permission slips for school activities, and any other decision that facilitates the minor's educational experience.
Name of the minor student
Date of birth

MonthDayYear
Date
Last school or district the student attended
Name
Date of birth

MonthDayYear
Date
Home address
Telephone number(s)
Email address
example@example.com
I am a relative of the minor (grandparent, aunt, uncle, sibling)

YesNo, I'm not related to the minor
General Information

Please check one and provide additional information if it is available:
The student is staying at my home address, as listed above.
The student is staying at the following location if not at my address:
Please check any that apply:
While I am currently helping with the care of the minor student, I DO NOT wish to assist school officials with the making of education-related decisions.
I have notified the parent(s) or the other person(s) having legal guardianship of the minor of my intent to assist school officials with making education-related decisions in the best interest of the student and have received no objection.
Please provide the name and phone number for the parent:
I am unable to contact the parent(s) or legal guardian(s)
Caregiver Signature

Clear
Date

MonthDayYear
Date
GUIDELINES TO DETERMINE ELIGIBLE STUDENTS THE ARIZONA DEPARTMENT OF EDUCATION PROVIDES THE FOLLOWING FY 2023 INCOME GUIDELINES FOR DETERMINING ELIGIBILITY INFORMATION FOR FEDERAL FUNDING ASSOCIATED WITH PROGRAMS FUNDED UNDER THE ELEMENTARY AND SECONDARY EDUCATION ACT (ESEA)
Is YOUR FAMILY AT OR BELOW THE CURRENT INCOME GUIDELLINES BASED ON THE FOLLOWING ESEA ELIGIBILITY GUIDELINES SCHEDULE?

DEFINITION OF INCOME: ALL ITEMS SUCH As WAGES AND SALARIES BEFORE ANY DEDUCTIONS. AND OTHER INCOME, SUCH As SELF-EMPLOYMENT, WELFARE, SOCIAL SECURITY, RETIREMENT BENEFITS, UNEMPLOYMENT COMPENSATION, AID FOR DEPENDENT CHLDREN, ALIMONY, CHILD SUPPORT, PENSIONS, INSURANCE, OR ANNUITY PAYMENT.

Household Size Indicator1 (Yearly) Indicator2 (Yearly)

1 $18,945 $26,973

2 $25,636 $36,482

3 $32,318 $45,991

4 $39,000 $55,500

5 $45,682 $65,009

6 $52,364 $74,518

7 $59,046 $84,027

8 $65,728 $93,536

*Each Additional Member Add: +$6,682 +$9,509
Select an Indicator for your income

Indicator 1-My yearly income and household fall at or underIndicator 2-My yearly income and household fall at or underNo-My yearly income and household is over
Child's Name/Children's Names (you can add more than one)
Name(s) of School(s) (you can add more than one)
Grade(s) of the Child/Children (you can add more than one)
I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE AND ACCURATE
PARENTGUARDIAN ADULT STUDENT SIGNATURE

Clear
DATE

MonthDayYear
Date
DISCIPLINE POLICY
WE (PARENT/STUDENT) HAVE RECEIVED AND UNDERSTAND THE PPEP TEC HIGH SCHOOL PARENT/STUDENT HANDBOOK, INCLUDING DISCIPLINE POLICIES AND PROCEDURES, AND THE MISUSE OF COMPUTERS AND INTERNET. WE (PARENT/STUDENT) ALSO UNDERSTAND THE CONSEQUENCES SHOULD I (STUDENT) VIOLATE ANY OF THE PPEP TEC POLICIES.

THE SIGNATURES BELOW INDICATE AGREEMENT To ABIDE BY THESE POLICIES AND PROCEDURES
PARENTGUARDIAN NAME PLEASE PRINT
PARENTGUARDIAN SIGNATURE

Clear
DATE

MonthDayYear
Date
STUDENT SIGNATURE

Clear
DATE

MonthDayYear
Date
PARENT/STUDENT AFFIRMATION FORM CONCERNING LEGAL ACTION
We (Parent/Student) hereby affirm that the student enrolling at PPEP TEC High School is currently:

Not on probationIs on probation
IF ON PROBATION, PLEASE PROVIDE THE FOLLOWING INFORMATION:
PROBATION START DATE

MonthDayYear
Date
PROBATION END DATE

MonthDayYear
Date
PROBATION OFFICERS NAME
PROBATION OFFICER'S PHONE
* IF ON PROBATION, I (PARENT/GUARDIAN)...........to Release Academic, Behavioral, and Attendance Information to the Enrolling Student's Probation Officer.

Give PermissionDo Not Give Permission
PARENTGUARDIAN/ADULT STUDENT SIGNATURE

Clear
DATE

MonthDayYear
Date
MIGRANT AGRICULTURAL STUDENT IDENTIFICATION FORM
PPEP TEC SITE
STUDENT NAME
GRADE
PARENTS NAME
WhatsApp PHONE NUMBER
HAS YOUR FAMILY MOVED IN THE LAST 3 YEARS TO SEEK AGRICULTURAL WORK? IS THE STUDENT A DEPENDENT OF AN AGRICULTURAL WORKER?

YesNo
HAS YOUR FAMILY MOVED IN THE LAST 3 YEARS TO SEEK AGRICULTURAL WORK? IS THE STUDENT A DEPENDENT OF AN AGRICULTURAL WORKER?

YesNo
Agricultural Work Includes:
- Agricultural Activities as the processing of:
  - Crops
  - Dairy Productions
  - Poultry
  - Livestock
- Cultivation of fish or fish farms including:
  - Shellfish
  - Catfish
  - Eels
  - Oysters
  - Clams
- Cultivation or Harvesting of Trees:
  - Soil Preparation
  - Planting
  - Tending
PPEP TEC HIGH SCHOOL PARENT PERMISSION FOR TITLE I INTERVENTION SERVICES
IT IS THE MISSION OF PPEP TEC HIGH SCHOOL TO EMPOWER EACH STUDENT TO ACHIEVE HIS DR HER FULLEST POTENTIAL TO BECOME A LIFELONG LEARNER AND RESPONSIBLE CITIZEN. WE ARE COMMITTED TO FOSTERING HIGH EXPECTATIONS AND PROMOTING ATTITUDES IN ORDER TO ACHIEVE EQUITY AND EXCELLENCE IN A SAFE AND NURTURING ENVIORNMENT.

IN KEEPING WITH THIS COMMITMENT, PPEP TEC HIGH SCHOOL OFFERS THE FOLLOWING TITLE I INTERVENTION SERVICES TO ELIGIBLE STUDENTS ATTENDING PPEP TEC HIGH SCHOOLS WITH TITLE I PROGRAMS:
1. READING AND MATH ACHIEVEMENT: TITLE I PARAPROFESSIONALS SUPPORT THE REGULAR EDUCATION ENGLISH AND MATH TEACHERS USING THE TITLE I PUSH-IN AND PULL OUT PROGRAM MODELS. THROUGH THESE MODELS, TITLE I PARAPROFESSIONALS PROVIDE SMALL GROUP AND ONE-ON-ONE INTERVENTION TO ELIGIBLE STUDENTS. AT SOME SCHOOLS, TITLE I PARAPROFESSIONALS ARE ALSO AVAILABLE BEFORE AND AFTER SCHOOL FOR FURTHER INTERVENTION TO ELIGIBLE STUDENTS.
2. Extended Learning Time: When fundig permits, PPEP TEC High School also allocates funding to support Title 1 Summer School programs at schools with high populations of eligible students who are priorityr for Title 1 services.
3. Supplemental Educational Materials: PPEP TEC High School also provides the necessary educational materials to support Title 1 programs at no cost to students. Educational materials may include, but are not limited to, workbooks, software programs, and lower reading level books and novels.
IN ORDER TO BE ELIGIBLE OR TITLE I SERVICES, STUDENTS MUST BE: 1 NOT OLDER THAN 21 WHO ARE ENTITLED TO FREE PUBLIC EDUCATION THROUGH GRADE 12; AND 2 NOT MET STATE STANDARDS ON ONE OR MORE AIMS/AZ MERIT TESTS READING AND/OR MATH STUDENTS IN 12TH GRADE WHO HAVE NOT MET STATE STANDARDS ON ONE OR MORE OF THE AzSCI/ACT TESTS ARE PRIORITY FOR TITLE 1 INTERVENTIONS SERVICES.

IF YOUR CHILD IS IDENTIFIED AND ELIGIBLE FOR ANY OF THE TITLE I INTERVENTION SERVICES MENTIONED ABOVE, YOU AGREE TO ENROLL YOUR CHILO INTO THE PPEP TEC HIGH SCHOOL TITLEI INTERVENTION PROGRAM BY SIGNING THIS FORM. YOU WILL BE NOTIFIED ABOUT THE TITLE I INTERVENTION SERVICES THAT YOUR CHILD IS RECEIVING, AS WELL AS YOUR CHILD'S PROGRESS AND ACHIEVEMENTS, THROUGH ANY OF THE FOLLOWING FORMS OF COMMUNICATION: TITLE I PROGRESS REPORTS; PARENT-TEACHER CONFERENCES, OR A LETTER OR PHONE CALL HOME.

IF YOU WOULD LIKE MORE INFORMATION ABOUT THE PPEP TEC HIGH SCHOOL TITLE I INTERVENTION PROGRAM, PLEASE CONTACT THE LEAD TEACHER OF THE SCHOOL WHERE YOUR CHILD IS ENROLLED.

AS MEMBERS OF THE PPEP TEC HIGH SCHOOL EDUCATION COMMUNITY, WE ARE ALL PARTNERS IN YOUR CHILD'S EDUCATION. THANK YOU FOR ALLOWING PPEP TEC HIGH SCHOOL TO SERVE THE EDUCATIONAL NEEDS OF YOUR CHILD.
PARENTAL CONSENT OF PARTICIPATION AND RELEASE OF INFORMATION
FOR SPECIAL EDUCATION STUDENTS ONLY

UNDER A RECENT CHANGE IN FEDERAL LAW, PPEP TEC HIGH SCHOOL WILL BE COLLABORATING WITH ARIZONA HEALTH CARE CONTAINMENT SYSTEM (AHCCCS) IN A PROGRAM THAT WILL ALLOW US TO BILL FOR MEDICALLY NECESSARY SERVICES RELATED TO THEIR SPECIAL EDUCATION PROGRAM. EXAMPLES OF THESE SERVICES ARE OCCUPATIONAL, PHYSICAL, OR SPEECH THERAPY, COUNSELING, SPECIALIZED TRANSPORTATION, NURSING SERVICES, OR AIDE ASSISTANCE, WHICH ARE DETERMINED TD BE MEDICALLY/EDUCATIONALLY NECESSARY BY THE IEP TEAM.

WHETHER OR NOT YOUR STUDENT IS CURRENTLY AHCCCS ELIGIBLE, WE ARE REQUESTING THAT YOU SIGN THE CONSENT FORM BELOW IN ORDER FOR US TO BILL FOR REIMBURSEMENT, IF APPROPRIATE. SIGNING AND RETURNING NOW WILL ALLOW US TO BE REIMBURSED IF YOUR CHILD IS CURRENTLY ELIGIBLE OR SHOULD EVER BECOME ELIGIBLE. THEREFORE, WE ARE ATTEMPTING TD GATHER CONSENT FORMS FROM ALL PARENTS. IF YOUR STUDENT NEVER BECOMES AHCCCS ELIGIBLE, NO BILLING OR REIMBURSEMENT WILL BE PROCESSED.

PLEASE SIGN THIS LETTER ALLOWING US TO BILL AHCCCS FOR THESE SERVICES PROVIDED AT SCHOOL. THE MEDICAID REIMBURSEMENT PROGRAM WILL HELP PROVED IMPROVED QUALITY SERVICES FOR OUR STUDENTS. WE APPRECIATE YOUR COOPERATION - THANK YOU

IF YOU HAVE QUESTIONS, PLEASE CONTACT THE DIRECTOR OF SPECIAL EDUCATION AT (520) 741-4393.
Students Name
Date of Birth

MonthDayYear
Date
AHCCCS ID Number if applicable
If my child, whose name is listed above, is eligible or should become eligible in the future, for Medicaid Health Coverage, PPEP TEC High School has my permission to release information from education records regarding special education and related services my child receives to the Arizona Health Care Cost Containment System (AHCCCS) for billing purposes. I understand that the Charter may receive partial reimbursement for some of the special education or related services he/she receives. I also understand that I may revoke my permission at any time.

Please note PPEP TEC is committed to providing the best educational opportunity to every student. We ask for the above information in order to ensure continuity of services in keeping with that commitment
SIGNATURE OF PARENT OR GUARDIAN

Clear
DATE

MonthDayYear
Date
*Federal Law mandates that Special Education records be destroyed four years after the last fiscal year your child attended PPEP TEC High School. You will receive a copy of your child's records at every meeting, and you may obtain additional copies at any time. You are encouraged to keep a copy of all your child's records as they may be of substantial value in social security issues or other educational experiences in the future. You will be notified at least one month prior to the destruction of the records and will have the opportunity to have them sent to you rather than be destroyed.
Parent/Student Permission for Instruction on AIDS and Other Sexually Transmitted Diseases
Please Select an Option Below

YES -- I give permission for my son/daughter to receive instruction on AIDS and other sexually transmitted diseases, and understand that this is part of [] the PPEP TEC High School Health curriculum.NO -- I do not give permission for my son/daughter to receive instruction on AIDS and other sexually transmitted diseases, although understand that this is part of the PPEP TEC High School Health curriculum.I am of the age of majority (18 years or older) and do not need parental permission to receive instruction on AIDS and other sexually transmitted diseases, and understand that this is part of the PPEP TEC High School Health curriculum.
STUDENT SIGNATURE

Clear
DATE

MonthDayYear
Date
PARENT OR GUARDIAN SIGNATURE

Clear
DATE

MonthDayYear
Date
PPEP TEC High School Student Photo/Video Release

I hereby grant permission to PPEP TEC High School to use photographs/videos taken of my child on its web site, other official school printed material/publications, or released to the media without compensation. I also acknowledge that PTHS has the right to crop or treat the photographs/videos at its discretion. I also acknowledge that PTHS may choose not to use the photographs/videos at this time, but may do SO at its own discretion at a later date.
STUDENT'S NAME
DATE

MonthDayYear
Date
SCHOOL SITE
DATE

MonthDayYear
Date
PARENT OR GUARDIAN SIGNATURE

Clear
DATE

MonthDayYear
Date
AzSCI/ACT
I/We understand that standardized testing in the form of AzSCI/or ACT, is required by the State of Arizona. I/We will assure PPEP TEC High School that I/my student will attend school on standardized testing dates.
PARENT DR GUARDIAN SIGNATURE

Clear
DATE

MonthDayYear
Date
I hereby affirm that I have / have not (circle one) been expelled or am/am not in the process of being expelled from any other educational institution.
Parent/Student Affirmation Form Concerning Expulsion and Suspension
Select an option below for both the suspension and expulsion questions, please read carefully:

I hereby affirm that I have not been expelled or am not in the process of being expelled from any other educational institution.I hereby affirm that I have been expelled or I am in the process of being expelled from any other educational institution.
Type a question

I hereby affirm that I have not been suspended or am not in the process of being suspended from any other educational institution.I hereby affirm that I have been suspended or am in the process of being suspended from any other educational institution.
Please note: This information is not used to establish eligibility for enrollment. This information is important to the documentation of PPEP TEC High School's status as an Alternative School. However, according to A.R.S. §15-841(C), "a school district may refuse to admit any pupil who has been expelled from another educational institutionor who is in the process of being expelled from another educational institution." Any enrollment decision may be appealed to the Superintendent.
STUDENT SIGNATURE

Clear
DATE

MonthDayYear
Date
PARENT OR GUARDIAN SIGNATURE

Clear
DATE

MonthDayYear
Date
Student Internet Contract Parent & Guardian Internet Information
I understand and agree that by allowing me the use of the Internet, the school does not create a property right and that the school may revoke my access or privilege for any reason or no reason. I understand and will abide by the provisions and conditions of this contract. I understand that any violations of the previous provisions may result in automatic expulsion, the revoking of my user account, and appropriate legal action. I also agree to report any misuse of the information system to the Lead Teacher.

Students under the age of eighteen (18) must also have the signature of a parent or guardian who has read this contract

As the parent or guardian of this student, I have read this contract and understand that the PPEP TEC High School technology and internet service is designed for educational purposes. I understand that it is impossible for the school to restrict access on the system to controversial or inappropriate materials and I will not hold the school responsible for materials acquired on the network. I also agree to report any misuse of the information system to the school administrator. Misuse can come in many forms but can be viewed as any message sent or received that indicates or suggests pornography or obscenity, unethical or illegal solicitation or activities, racism, sexism, inappropriate language, and other issues described previously.
PARENT OR GUARDIAN SIGNATURE

Clear
DATE

MonthDayYear
Date
STUDENT SIGNATURE

Clear
DATE

MonthDayYear
Date
Public Notice to Parents
Recent legislation requires that PPEP TEC High School must notify all parents that teacher résumés are on file and available for review at the Administrative Offices located at 1840 E. Benson Highway, Tucson, Arizona. Should you wish to review a teacher's résumé, please contact the Administrative Office at (520) 294-6997
Notice of Privacy Practices

I have received a copy of the PPEP TEC High School "Notice of Privacy Practices," and | understand PPEP TEC High School's policy regarding the protection of my son/daughter's health records.
PARENT DR GUARDIAN SIGNATURE

Clear
DATE

MonthDayYear
Date
STUDENT RECORDS REQUEST
Student Name
Date of Birth

MonthDayYear
Date
Previous School
WE (PARENT/STUDENT) HEREBY AFFIRM THAT THE STUDENT ENROLLING IN PPEP TEC HIGH SCHOOL Is CURRENTLY:

Not On ProbationOn Probation
Should be Empty:

PPEP TEC HIGH SCHOOL

LIST OF REQUIRED DOCUMENTS

THE FOLLOWING DOCUMENTS MUST BE SUBMITTED FOR ENROLLMENT IN PPEP TEC HIGH SCHOOL

PPEP TEC HIGH SCHOOL

STUDENT ENROLLMENT FORM

STUDENT INFORMATION

MAILING ADDRESS (IF DIFFERENT FROM ABOVE)

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACT INFORMATION

HEALTHCARE INFORMATION

ARIZONA DEPARTMENT OF EDUCATION

Arizona Department of Education

State of Arizona

PPEP TEC

STUDENT RESIDENCY QUESTIONNAIRE

STUDENT RESIDENCY QUESTIONNAIRE

CAREGIVER'S AUTHORIZATION AFFIDAVIT

General Information

Please check any that apply:

GUIDELINES TO DETERMINE ELIGIBLE STUDENTS THE ARIZONA DEPARTMENT OF EDUCATION PROVIDES THE FOLLOWING FY 2023 INCOME GUIDELINES FOR DETERMINING ELIGIBILITY INFORMATION FOR FEDERAL FUNDING ASSOCIATED WITH PROGRAMS FUNDED UNDER THE ELEMENTARY AND SECONDARY EDUCATION ACT (ESEA)

DISCIPLINE POLICY

PARENT/STUDENT AFFIRMATION FORM CONCERNING LEGAL ACTION

IF ON PROBATION, PLEASE PROVIDE THE FOLLOWING INFORMATION:

MIGRANT AGRICULTURAL STUDENT IDENTIFICATION FORM

PPEP TEC HIGH SCHOOL PARENT PERMISSION FOR TITLE I INTERVENTION SERVICES

PARENTAL CONSENT OF PARTICIPATION AND RELEASE OF INFORMATION

Parent/Student Permission for Instruction on AIDS and Other Sexually Transmitted Diseases

AzSCI/ACT

Parent/Student Affirmation Form Concerning Expulsion and Suspension

Student Internet Contract Parent & Guardian Internet Information

Public Notice to Parents

Notice of Privacy Practices

STUDENT RECORDS REQUEST