Encompass Community School K-3 Registration Packet

Encompass Community School K-3 Registration Packet
Only a custodial parent or legal guardian may register a student.

A legal guardian must show proof of guardianship by presenting a Record of Birth, custody papers, a court order or DCS Educational Passport.*

*Incomplete packets will not be accepted or held by Encompass Community School*
STUDNET NAME

First NameLast Name

With whom does the student reside?

Parent(s)Legal Guardian(s)Caregiver(s) who are not legal guardian(s) (ex. relatives, friends, friends of parents)Other
Statement of Residence: Where does the student stay at night?
If other, please specify:
Is this child awaiting foster care placement? If so, explain below.

Student Records Request For Rising 1st - 3rd Graders ONLY
If your student is entering 1st-3rd grade, you may complete the records request to withdraw them and authorize the release of their cumulative files from their current school. You WILL NOT need to upload any documents.

See Encompass staff if anything has changed.
Student Information
Student Name

First NameLast Name
Student Date of Birth

MonthDayYear
Date
Student ID Number (Leave blank if you are unsure)
Current Grade
Transferring School Information
Name of School Being Withdrawn From:
New School Information: Please forward the student's cumulative record including academic records, health records, disciplinary records, attendance report, and scholarship record in accordance with the Family Education Rights and Privacy Act, codified at 20 U.S.C. § 1232g.
This request for student records is being made on behalf of the undersigned parent/guardian for the purpose of school transfer.
Parent/Guardian Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.
Parent/Guardian Email Address
example@example.com
Signature

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Date

MonthDayYear
Date

For Kindergarten and First-Time School Students, please ensure you upload the following documents. SKIP if you have completed the Records Request.
Proof of Residence

Cancelof
Parent/Guardian Photo ID

Cancelof
Student Record of Birth

Cancelof
Current TN Immunization Certificate (unless appropriate medical or religious exemption documentation is provided) Students transferring from another TN school have 30 days to provide proof of immunization.

Cancelof
School Physical (If on the same form as shot records, you can skip!)

Cancelof
Proof of Guardianship (if applicable) custody papers, court order of DCS Educational Passport. (See Encompass staff if you do not have this.)

Cancelof
Check the box that best describes with whom the student resides. (Note: Legal guardianship may only be granted by a court.)

Parent(s)Legal Guardian(s)Caregiver(s) who are not legal guardian(s) (example: relatives, friends, parents of friends, etc.)Other
If other, explain.
Is this student awaiting foster care placement? If so, please explain

Home Language Survey

Only to be completed for students enrolling from outside of Tennessee or first-time enrollment in a school.
1. What is the first language your child learned to speak?
2. What language does this child speak most often outside of school?
3. What is the language that is most often spoken to this child at home?
Signature

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Please list students in the same household that are enrolled in a Public or Charter School

Leave blank if there are no other students enrolled in a public/charter school
Name

Last NameFirst Name
Date of Birth

MonthDayYear
Date
School Name
Name

Last NameFirst Name
Date of Birth

MonthDayYear
Date
School Name
Name

Last NameFirst Name
Date of Birth

MonthDayYear
Date
School Name
Emergency Contacts to call, in order listed below, if school personnel cannot reach parent or guardian:
Contact Name #1:

Last NameFirst Name
Contact #1 Birth Date

MonthDayYear
Date
Relationship to Student
Phone Number
Please enter a valid phone number.
Gender
Contact Name #2:

Last NameFirst Name
Contact #2 Date of Birth

MonthDayYear
Date
Relationship to Student:
Phone Number
Please enter a valid phone number.
Gender

Legal Notice
Are there any court orders or Legal issues involving this student?
(If you answered yes regarding Legal Notice, you must provide a current Magistrate/Judge signed court order document.)

Cancelof

Student Health Information
Does your child have any health conditions or medical needs?

YesNo
Please upload any documentation related to the student's health conditions

Cancelof
Please upload any documentation related to the student's health conditions

Cancelof
I certify that I am the parent or guardian of the child named above and I have provided Encompass Community School with accurate information as required by State Law and that the above address is the primary residence where my child and I live. I will notify the school of any change in residency status within 10 days of that change.

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Date

MonthDayYear
Date
Should be Empty:

Student Records Request For Rising 1st - 3rd Graders ONLY