Language
  • English (US)
  • Spanish (Latin America)

  • GOSHEN COMMUNITY SCHOOLS

  • TITLE 1 PRESCHOOL

  • Students Date of Birth*
     / /
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Ethic Group:*
  • Race:*
  • Does your child have prior preschool experience?*
  • Have you had a child in our Title 1 Preschool program in the past?*
  • Do you have other children who currently qualify for the free/reduced lunch program in Goshen Community Schools?*
  • IF not, do you believe you will qualify for free/reduced lunch?
  • Is your child independent with toileting, including wiping on their own?*
  • Does your student receive any special education or speech services?*
  • How did you hear about the Title 1 Preschool?*
  • Date
     - -
  • Image field 216

  • 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 a Indiana school, and remains 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.

  • Date of Birth*
     / /
  • Have you completed an Indiana Home Language Survey for your student before?
  • What is the native language of the student?*
  • What language(s) is spoken most often by the student?*
  • What language(s) is spoken by the student at home?*
  • FOR PARENT- What language(s) do you prefer to receive school communications?

  • 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.

  • Date
     / /

  • 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

  • Format: (000) 000-0000.
  • Rows

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

  • Format: (000) 000-0000.
  • Home address same as primary address
  • Rows
  • Rows

  • 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.

  • Format: (000) 000-0000.
  • Within the last three years, have your children moved for any reason?*
  • Has anyone in your household moved from one school district to another within the United States, to look for seasonal or temporary work in agriculture?*
  • Please check any of the agricultural activities listed below that you have looked for or worked in:
  • Rows
  • Date
     / /

  • Student Handbook Acknowledgement Form

    The student handbook is presented to assist you in your understanding of the general operation of the school.  Goshen Community Schools consists of one high school, one junior high school, one intermediate and six elementary schools. Each operates under the rules, regulations, and policies as established by the State of Indiana, the Board of School Trustees, and directives from the Office of the Superintendent.  Each school, however, may have some variations in general administrative procedures to provide for differences that exist in various parts of the district. Your acknowledgement and understanding of school policies is important in helping your child make a satisfactory adjustment to the school community. Forpublic information about school policy, go to https://go.boarddocs.com/in/goshen/Board.nsf/Public The student handbook can be located by visiting www.goshenschools.org/school-handbooks Please take the time to visit the handbook for rules, guidelines, procedures, and policies of the school corporation.  It is all pertinent information, but please pay close attention to: ·        Code of conduct ·        Attendance·        Technology Agreement·        Cell phone usage·        Dress code

  • 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.

  • Date
     / /

  • STUDENT HEALTH HISTORY

  • Birth Date*
     / /
  • Rows
  • Does your child have asthma?*

  • IF YES, Asthma action plan is required. If moderate or severe, a doctor's signature is required on this plan.

  • Does your child have allergies?*
  • If yes, is Epipen prescribed?*

  • IF YES,

    SELF MEDICATION FORM/EMERGENCY PLAN FROM DR. IS REQUIRED
  • Does your child have seizures?*
  • Does your child have diabetes?*

  • If yes, diabetic care plan from doctor is required

  • Is your student currently on any medication, prescription or over the counter?*
  • Is the medication required during school hours?*

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

  • Date
     / /
  • Format: (000) 000-0000.
  • Does your student have any special education services, including but not limited to speech or physical therapy?

  • Elkhart County Special Education Cooperative (ECSEC)

    Transfer Student Enrollment Form

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

  • ECSEC

  • DATE
     / /
  • Gender:
  • Ethnic Background
  • Format: (000) 000-0000.
  • Does this student live in foster care?
  • Does this child need an educational surrogate parent?
  • Format: (000) 000-0000.
  • Did you bring student's IEP?

  • 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. 

  • Click all that apply:
  • Should be Empty: