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  • GOSHEN COMMUNITY SCHOOLS

  • TITLE 1 PRESCHOOL

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  • HOME LANGUAGE SURVEY (HLS)

    The purpose of this survey is to determine the primary or home language of the student. The HLS must be given to all students enrolled in the school district. The HLS is administered one time, upon initial enrollment in Indiana, and remain in the student’s file.Indiana school districts are required to determine the language(s) spoken in each student’s home to identify their specific language needs, per the Civil Rights Act of 1964, Title VI, Language Minority Compliance Procedures.Please note that the answers to the survey below are student specific. If a language other than English is recorded for ANY of the survey questions below the student will be given a test to determine whether the student will qualify for additional English Language Support.
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  • By signing here, you certify that responses to the three questions above are specific to your student. You understand that if a language other than English has been identified, your student will be tested to determine if they qualify for English language development services, to help them become fluent in English. If eligible for the English language development program, your student will be entitled to services as an English learner and will be tested annually to determine their English language proficiency.

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  • FAMILY AND EMERGENCY CONTACT INFORMATION

  • Primary Parent/Guardian- this parent/guardian's information will be used as the student's primary address and phone number

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  • Parent/Guardian 2- - Parent/Guardian 2 is the biological/legal parent sharing custody of the student)

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  • Indiana Department of Education- Work Survey

    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).

    THIS IS A REQUIRED FORM FOR ALL FAMILIES IN INDIANA.

  • 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.

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  • Custodial Questionaire

  • Goshen Community Schools policies are designed to keep custodial conflicts out of the school setting. Our policies seek to ensure the safety of all our students. Goshen Community Schools needs a copy of all court documents related to custody, paternal rights, paternity, etc.

    Because of Indiana Law, IC 31-14-7-1 related to legal custody, we need you to answer the following questions:

     

  • If not, please provide any legal documents within 30 days of enrollment to ensure we adhere to any custody guidelines

  • INDIANA STATE DEPARTMENT OF HEALTH'S CHILDREN AND HOOSIERS IMMUNIZATION REGISTRY PROGRAM (CHIRP)

    For access to Indiana immunization records.

  • I,   *   *   parent/guardian of   *   *   , date of birth   Pick a Date*   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.

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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 MEDICATION FORM/EMERGENCY PLAN FROM DR. IS REQUIRED

  • If yes, diabetic care plan from doctor is required

  • If yes, obtain necessary permissions form from the school nurse.

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  • Elkhart County Special Education Cooperative (ECSEC)

    Transfer Student Enrollment Form

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

  • ECSEC

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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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