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  • RETURN STUDENT ENROLLMENT

    ONLY COMPLETE IF YOUR STUDENT HAS ATTENDED GOSHEN COMMUNITY SCHOOLS BEFORE

  • Student Information

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  • Student Birth Place

  • Student Demographics

  • Former School Information

  • IF YES, PLEASE ENSURE THE ATTACHED ECSEC TRANSFER FORM IS COMPLETED

    It will be at the end of the enrollment process

  • I confirm that I have the authority to request that Goshen Community Schools update the information for the children on this form.

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  • FAMILY AND EMERGENCY CONTACT INFORMATION

  • Parent/Guardian 1 will be the primary address and phone number for the student. Complete chart for each parent/guardian.

  • Parent/Guardian 2- This is for biological parent or guardian that the student shares time with.  If address is the same as Parent/Guardian 1, state SAME AS ABOVE. 

     

  • PLEASE ADD AT LEAST ONE ADDITIONAL EMERGENCY CONTACT.

     

  • EMERGENCY CONTACTS- by adding an individual below you are giving permission to your student's school to call and pick up the student if primary contacts are not available.

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  • Indiana Education Migrant Form- Required state form

    For families that migrant (move) for the purpose of agricultural employment

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    The Migrant Education Program (MEP) provides supplemental education and support services to eligible children through national funding. The purpose of the program is to ensure that all migrant students reach the academic standards and graduate with a high school diploma (or complete GED/HSE)

  • WORK SURVEY

  • Thank you for answering the following questions. If your child is eligible for the Migrant Education Program, they may receive additional educational support. This information is strictly confidential.

  • When was the last time you or anyone in your household has moved to look for, or work in agricultural activity within the United States?

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  • GOSHEN COMMUNITY SCHOOLS RESIDENCY INFORMATION FORM

  • This questionnaire is in compliance with the McKinney-Vento Act, U.S.C.A. 42 Section 11302(a Your answers will help the administrator determine residency documents necessary for enrollment of your student(s UHPA sends this questionnaire to all parent(s)/guardian(s)/unattached youth Aug. 31 and Jan. 31 in accordance with legal requirements.

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    Residency and Educational Rights

    Students who are in temporary, inadequate, and homeless living situations have the following rights:

    1) Immediate enrollment in the school they last attended or the school in whose attendance area they are currently staying even if they do not have all the documents normally required at the time of enrollment. Access to free meals and textbooks, Title I and other educational programs, and other comparable services including

    2) transportation.

    3) To attend the same classes and activities that students in other living situations also participate in without fear of being separated or treated differently due to their housing situations.

    Any questions about these rights can be directed to the UHPA McKinney-Vento Liaison, Dr. Alan Metcalfe at 574-533-8631or the State Coordinator at (800) 833-2199. By signing below, I acknowledge that I have received and understand the above rights.

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  • Indiana State Department of Health’s Children and Hoosiers Immunization Registry Program (CHIRP)

  • I,parent/guardian of       , give Goshen Community Schools permission to release the following information to the Indiana State Department of Health’s Children and Hoosiers Immunization Registry Program (CHIRP): All immunization records and personal identifying information from the CHIRP data base. For example, but not limited to: name, address, phone number, birth date, school name.

    I understand that the information in the registry may be used to verify that my child has received proper immunizations and to inform me or my child of my child’s immunization status or that an immunization is due according to recommended immunization schedules.

    I understand that my child’s information may be available to the immunization data registry of another state, a healthcare provider or a provider’s designee, a local health department, an elementary or secondary school, a childcare center, the office of Medicaid policy and planning or a contractor of the office of Medicaid policy and planning, a licensed child placing agency, and a college or university. I also understand that other entities may be added to this list through amendment to I.C. 16-38-5-3.

    I hereby consent to the release of such information.

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  • STUDENT HEALTH HISTORY

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  • If yes, Asthma Action Plan is required. If moderate or severe, a doctor's signature is required on this plan. 

     

  • If yes, Self Med. Form/Emergency Care Plan from Dr. is required.

     

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  • If yes, Seizure Care Plan from Dr. is required.

  • If yes, Diabetic Care Plan from Dr. is required.

  • Medication

  • If yes, please obtain necessary permission form from the nurse.

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    I understand may need to share information about my child's condition with appropriate school staff. This will be done in a confidential manner. If I do not wish that information shared, I must request this in writing and file it with the school nurse.

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  • ONLY COMPLETE IF THE STUDENT HAS SPECIAL NEEDS, AN IEP, OR SPEECH

  • ECSEC TRANSFER FORM

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  • REQUEST FOR CONFIDENTIAL REPORTS AND RECORDS

    I hereby give my consent to disclose the existing records specified below. I have been informed that I have access to and may review any or all of my child=s school records as outlined by the Family Educational Rights and Privacy Act (FERPA) of 1974.

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