Application Admissions

Oklahoma School for the Deaf

Application for Admission

Family Information

Guardian 1
Name*

First NameMiddle NameLast Name
Relationship*
Address*

Address

Street Address Line 2

CityState

Zip
Home Telephone
Video Phone
Cell Phone
Email address *
example@example.com
Place of Employment
Work phone
Position
Education Completed:*

ElementaryHigh SchoolCollegeGraduate Level

Family Information

Guardian 2
Name

First NameMiddle NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home phone
Video Phone
Cell Phone
Email Address
example@example.com
Place of Employment
Work phone
Position
Education Completed:

ElementaryHigh SchoolCollegeGraduate Level
With whom does the child live?*
Relationship*
Who has legal custody?*

SIBLING(S) OF CHILD
Name
Sibling #1
Gender
Birth date

MonthDayYear
Date
Deaf or Hearing
Name
Sibling #2
Gender
Birth date

MonthDayYear
Date
Deaf or Hearing
The following persons are authorized to take my child from campus
Name*
Name
Name
Name

Emergency Telephone Numbers
1. Name*
Phone Number*
City/State*
Relationship*
2. Name*
Phone Number*
Please enter a valid phone number.
City/State*
Relationship*
3. Name
Phone Number
Please enter a valid phone number.
City/State
Relationship

Student Background Information
Has your child had a psychological or educational evaluation?*

YesNo
If yes, when?
Where?
What were you told?
History of Hearing Loss and other disabilities
What is your child’s hearing loss?*
When was your child first identified as having a hearing loss?*
Does your child wear hearing aids?*
If so, one or two?*
At what age was your child fitted with hearing aids?
Brand?
Name/Serial number of aids?
Does anyone else in your family have a hearing loss? If so, please indicate below
Father
Age Loss Occurred
Education at a School for the Deaf
Mother
Age Loss Occurred
Education at a School for the Deaf
Siblings Hearing Loss
Age Loss Occurred
Education at a School for the Deaf
Other
Age Loss Occurred
Education at a School for the Deaf
Does your child have any other handicapping conditions or health concerns? Please Explain

I hereby make application for admission of my child to the Oklahoma School The Deaf, Sulphur, Oklahoma. If admitted, I agree that my child will Abide by the Policies and procedures of the school that have been approved by the Oklahoma Department of Rehabilitation Services and printed in the school handbook.

I understand that any information provided that is not true, can be reason for non admittance, or removal from OSD after enrollment. In case of emergency, illness or accident regarding immediate operation or surgical procedure in the opinion of the attending physician, I request that I be contacted and in the event I cannot be immediately reached, I authorize the Superintendent of the school to act in my stead in my child’s behalf.

I hereby give my consent for the school to administer screening test to my child for visual acuity, hearing acuity, speech pathology and to administer such evaluation procedures as it deems necessary for the placement and administration of an education program designed to meet the needs of my child. I further give my consent for the administration of various standardized or teach devised tests that are needed to measure my child’s achievement in any educational area. The authorization shall be in effect as long as my child is a student of the Oklahoma School for the Deaf.
Signature of Parent/Guardian *

Clear
Date*

MonthDayYear
Date
Or attending Professional

In compliance with the 1964 Civil Rights Act, no person shall be excluded from participation, denied any benefits of subject to discrimination on the basis of race, color or national origin. In compliance with Title IX of the Education Amendments of 1972, the Department’s policy is that no student or employee at the Oklahoma School for the Deaf shall, on the basis of sex be excluded from participation in any educational endeavor or other activity sponsored by the school. Parents are granted full and free right to examine information, which is collected at the school services records, disciplinary records and medical reports.

STATE OF OKLAHOMA STANDARD FORM CONSENT FOR THE RELEASE OF CONFIDENTIAL INFORMATION
I understand that these records are protected under federal and State confidentiality regulations and cannot be released without written consent unless otherwise provided for in the regulations. Federal regulations prohibit further disclosure of the records without specific written consent, or as otherwise permitted by such regulation. I also understand I may revoke this consent in writing at any time unless action has already been taken based upon this consent and in any event this consent expires one year from the date of signature.
AUTHORIZING PERSON*

CHILDPARENTGUARDIANLEGAL CUSTODIANOther
request that information concerning:
NAME OF CHILD*
DATE OF BIRTH*

MonthDayYear
Date
SSN*
If the records to be disclosed are education records (which may include discipline records), they are maintained and released in accordance with the Family Educational Rights and Privacy Act (FERPA Parents or eligible students shall be provided a copy of the records to be disclosed if requested. Redisclosure, except as provided at 34 CFR § 99.31, requires prior consent of parents or eligible students.
(signature of person(s) authorizing release)*

Clear
(date)*

MonthDayYear
Date

Notification of Rights under FERPA for Elementary and Secondary Institutions
The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that affords parents and “eligible students” over 18 years of age certain rights with respect to their child’s education records. They are:
- The right to inspect and review the child’s education records within 45 days from the day the school district receives a request for access.
Parents or eligible students must submit a written request to the school principal or appropriate school official that identifies the record(s) they wish to inspect. This school administrator will make arrangements for access to the education records and will notify the parent or eligible student of the time and place where these records may be inspected.
- The right to request correction of the child’s education records that the parent or eligible student believes is inaccurate, misleading, or otherwise in violation of the child’s privacy rights.
Parents or eligible students may ask the school district to amend a record they believe is inaccurate, misleading, or otherwise in violation of the child’s privacy rights. They must submit a written request to the school principal, clearly identify the part of the record they want changed, and specify why it is inaccurate or misleading or otherwise in violation of the child’s privacy rights.

If the school district decides not to make changes in the record as requested, the school district must notify the parent or eligible student of the decision and advise them of their right to a formal hearing regarding the request for correction. Additional information about hearing procedures will be provided to the parent or eligible student at the time of this notification.
- The right to consent to disclosures of personally identifiable information contained in the child’s education records, except to the extent that FERPA authorizes disclosure without consent (34 CFR § 99.31
School officials with legitimate educational interests are permitted disclosure without consent. A school official is a person employed by the school district as an administrator, supervisor, instructor, or support staff member, including health or medical staff and law enforcement unit personnel; a person serving on the school board; a person or company with whom the school district has contracted to perform a special task, such as an attorney, auditor, medical consultant or therapist, or a parent or student serving on an official committee, such as a disciplinary or grievance committee, or assisting another school official in performing his or her tasks.

A school official has a legitimate educational interest if that official needs to review an education record in order to fulfill his or her professional responsibility.

Upon request, the school district will disclose education records without consent to officials of another school district in which a student seeks or intends to enroll. (NOTE: FERPA requires a school district to state in its annual notification that it intends to forward records on request School districts may disclose, without consent, “directory” information; however, school districts must inform parents and eligible students about directory information, allowing them a reasonable amount of time to request that the school not disclose directory information about that child.

School districts must notify parents and eligible students annually of their rights under FERPA by means of a special letter, inclusion in a Parent/Teacher Association (PTA) bulletin, student handbook, and/or other means left to the discretion of each school district.
- The right to file a complaint with United States Department of Education concerning alleged failures by the school district to comply with requirements of FERPA. The name and address of the office that administers FERPA is: Family Policy Compliance Office, United States Department of Education, 400 Maryland Avenue, SW, Washington, D.C. 20202-5920.

Records Needed Prior to Enrollment
Application*
Date*

MonthDayYear
Date
- Copy of Social Security Card
- Copy of Birth Certificate
- Recent Picture of Student
- Current Immunization Record
- Medications: Does your child currently take medications? If so, are there any changes being made such as increasing, lowering dosage or taking your child off medications?
- Legal Documents: If parents are divorced or someone else has custody/guardianship of a child.
- Transcript/grades/state mandated testing reports
- All: RED, MEEGS and IEP
- Psychological Evaluation
- Audiogram
- Speech Evaluation
- Discipline Records
- Proof of Oklahoma residency (copy of utility bill that shows current residential address
Please Fax or email this information to Starla Davidson at (580)622-4905 or sdavidson@osd.k12.ok.us
For 7 – 12 grade only: List all sports child participates in school:
Should be Empty:

Oklahoma School for the Deaf

Application for Admission

Family Information

Family Information

SIBLING(S) OF CHILD

The following persons are authorized to take my child from campus

Emergency Telephone Numbers

Student Background Information

Does anyone else in your family have a hearing loss? If so, please indicate below

What type of language does your child use to communicate?

STATE OF OKLAHOMA STANDARD FORM CONSENT FOR THE RELEASE OF CONFIDENTIAL INFORMATION

Notification of Rights under FERPA for Elementary and Secondary Institutions

Student Behavior Profile

Records Needed Prior to Enrollment