creighton elementary school registration...
TRANSCRIPT
Creighton Elementary School Registration Information
Students me GwdC
At the tiIne of registration please present the following dOClunents
n 1 Childs Iumumization Records Child needs to have all the recluired immunizatIOns to ~
enroll schooL (Slop hv li( Nurses office to get clearance)
2 Childs birth certifieate Ch1ld must be 5 years of age on or beforegt SepLember 1 of year or 4 years of age on or before September 1 for Pre-Kindergarten
3 Childs social seeurity card bring your childs card that we can make a copy of it If your child does not have il social security number then a state PEIiVIS nUI11 will be llntil you arc able to a social security card for your child
4 Proof of resideney - 1 current utility bill with pi1rentlguardii1l1s name alld address 1S required Ex Lease agreement rental contract utility bill (home land line water gas electric or trash service) A drZuers lZcense is not accepted Special Circumstance If a student and parent are liuing with another famay member parent or custodial pOlpnl must present a notarizcd statement indicating 11ith uhoTn the parent alld student are lilnng Proof of resLdence j()r the family member must
5 Id Of the parent or legal guardian who is enrolling the student
6 School Records - Withdrawal Form and Report Card from prevIOus school (If any)
i---l 7 Legal Documentation (if applicable)-Ex Custody Papers Divorce Decrees Cuurt Pallers (they must be signed by judge)
8 PI ONLY Proof of income for last two months from both parents or a current food stamps letter from Texas Department of I-Iuman Services that confirms benefits have been
In order to registe) the attached forms need to be filled out completelY Only the biological parent custodial parent or court appointed legal guardian may enroll a child in school If you are the non-custodial parent you must have a notarized statement from the cllstndwl pment granting permission for the child to live with you as well as grant permission rOt you to enroll the child 111 school and make educationalmedical decisions for the clllid
If we may be of any help please c8lI us at 93G709-2900
Middle Last
Street Name Zip Code
I Mailing Address If different from
above Street Name City Zip
STUDENT RESIDES WITH
Circle One
Step Mother Step Father
J Guardianother Guardianother~ t i t I
Full Name i
Cell Phone Number
bull Work Number
Place of employment
IEmail Address
bullbullbullbullbullbullbullbullbullbullbull eow th hld er Ivm~ WItL1st b I e names 0 f any C 1 ren un d 18myour amlly or r h your famity
Name Age Grade In what school I
Student name
Campus
Military Connected Student Information
State law requires school districts to collect data related to students with connections to the military
Complete and return this form only if your child meets one of the following criteria
Student is a dependent of an Active Duty member of the United States military (Army NatY Air Force lvlarine Corps or Coast Guard)
Student is a dependent of a member of the Texas National Guard (Army Air Guard or State Guard)
Student is a dependent of a member of the reserve force in the United States military (AmlY Navy Marine Corps Coast Guard)
Pre-kindergarten student is a dependent of
1 An active duty uniformed member of the United States military (Army Navy Air Force 1vlarine Corps or Coast Guard)
2 An activatedmobilized uniformed member of the Texas National Guard (Army Air Guard or State Guard)
3 An activatedmobilized member of the United States reserve (Army Navy lvIarine Corps Air Force or Coast Guard)
4 Member of the United States military or reserve or Texas National Guard who was injured or killed while serving on active duty
ID number
Grade
Foster Care Status Information
State law requires school districts to collect data related to students who currently are in or have been in foster care under certain circumstances
Complete and return this form only if your child meets one of the following criteria
Student is currently in the conservatorship of the Department of Family and Protective Services
i J Pre-kindergarten student was previously in the conservatorship of the Department of Family and Protective Services following an adversary hearing held as provided by Section 262201 Family Code
PalelltGuardillll signaWI Dale
Cq~r SCOOlDiSTRICT ~~uZ~
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Parents Please complete back of form (page 2) Teacher check one r No-show lirst ~
ICONROEINDEPENDENT Registration Form - New Students ISCHOOL DISTRICT
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106Campus No 1 70902
Creighton Elementary SchoolCampus
last
Sex ______ Birth Date ~__~__~_~___ __Student ID
Student resides with Omother Ofather
Phone (home) ~___~__~__ (workL--- ___~____
Guardian Email addresses ---~----~-----------------------------------~-----------------~-
Students Physical Address _________ ------- --- shy-----------~ street address city zip
Street address city zip
Other parentguardian information if applicable
Name _________~_____________ ______________ Phone (home) ____~~__~ _ (worki_ _ ____~___
Physical Address ________~__ ----------~ street address city zip
Other ParentGuardian Email addresses __~_______________________
Warning It is a criminal offense pursuant to Texas Penal Code 3710 for a person to knowingly falsify information on a form required for a students enrollment in the District This is such a form
Parentguardian signature required for enrollment ofstudent Si es necesario por favor pedir la forma en espano
I am aware that in order for my child to attend school in the Conroe lSD my child must meet the districts residency requirements or be granted an approved Interdistrict transfer I acknowledge that 1have read and understand the penalties of falsified information as stated in the Texas Education Code sect25001 (h) printed below I also agree to inform the proper school authorities immediately should I move from the address indicated Proof of residency is required
Texas Education Code sect25001 h In addition to the penalty provided by sect3 71 0 of the Penal Code a person who knowingly falsifies information on a form required for
enrollment of a student in a school district is liable to the district if the student is not eligible for enrollment in the district but is enrolled on the basis of the false information The person is liable for the period during which the ineligible student is enrolled for the greater of
1) the maximum tuition fee the district may charge under sect25038 of this code or 2) the amount the district has budgeted for each student as maintenance and operating expenses
I hereby certify one of the following a)primary guardian is a resident (managing conservator or legal guardians) blother legal parent is a resident (possessory conservator) clstudent signing form is at least 18 years of age and a resident of the district or d)student has been granted an approved Interdstrct transfer I understand that one of these conditions must be maintained in order for the student to attend the Conroe ISO I also agree to inform the proper school authorities immediately should Imove from the address indicated above
With my signature I acknowledge that I have read and verify the information on this registration form and that I understand the penalties of providing falsified information as stated above
ParentGuardian Signature Date
In order to meet Texas Education Agencys recommended guidelines (ISO is using social security numbers for the required PEIMS Reporting Number If you choose not to provide this information please provide the Districts Legal Department with written objection within ten days of the issuance of this notice
The Conroe Independent School District does not discriminate on the basis of race color national origin sex religion age or disability in its admissiOns policies or by excluding from participation in denying access to or denying the benefits of district services academic andor vocational and technology programs or activities as required by Title VI and Title VII of the CiVil Rights Act of 1964 as amended Title IX of the Education Amendments of 1972 the First Amendment of the United States Constitution the Age Discrimination Act of 1975 Section 504 of the Rehabilitation Act of 1973 as amended and Title of the Americans with Disabilities Act
For information about Title IX rights contact the Title IX Coordinator 3205 W Davis Conroe Texas 77304 (936)709-7700 For information about Section S04ADA rights contact the Section 504ADA Coordinator 3205 W Davis Conroe Texas 77304 (936)709middot7670
Parents should forward any medical information allergies or medical problems to the attention of the campus ~J
Administrative Enrollment
Administrator or DiagnosticianSpeech Therapists signatureltitle Date PEIMS (410) front (page 1)
-----
---- ---- ------
Bus No
School Bus Registration Form
Please complete the following information to ensure access to transportation services Vithollt prior registration your student lIIay not be able to ride the school bus until proper registration has bccn received by the Transportation Department
(Please print)
Date Campus Creighton Elementary School
Students name Student ID
Will student be riding the bus this year (Place an X in the appropriate box)
Always Sometimes No
shy
Complete the student information below ONLY if your student will need to ride the school bus
Birthdate Age Sex Grade -~---~
Home address
Phone (HomeCell) _--_-------shy
ParentGuardian name
ParentGuardian work phone
Emergency Contact (when parent or guardian can not be rcached)
)Jame Relationship to student
Address ----- --------------------- ---_----- _----shy
Phone )Jumbers ----------------------_--------- _-shy
ParentGuardian Signature
Conloe Independent School District Student Residency Questionnaire
The information on this form is required to meet the law known as the McKinney-Vento Act 42 USc 11434a(2) which is also known as Title X Part C of the No Child Left Behind Act The answers you give will help the school determine the services the student may be eligible to receive
Presenting a false record or falsifying records is an offense IInder Section 37 JO Penal code and enrollment of the child under false documents subjects the person 10 liability for tuition or other costs TEe Sec 25 002 (3)(d)
Name of Student ___________----_______________ Gender 0 Male 0 Female
Last First Middle
Birth Date __-----_--_ CampusCreighton Elementary Grade ____ Student Month Day Year
Check the box that best describes with whom the student resides (Please note legal guardianship may be granted only by a court students living on their own or with friends or relatives who do not have legal guardianship are allowed to enroll in and attend schoo The school cannot require proofofguardianship for enrollment or continued attendance)
o Parent(s)
o Legal Guardians(s)
o Caregiver(s) who are not legal guardian(s) (Examples friends relatives parents offriends etc) o Other _________________________________________________________________
Name of person with whom student resides ___________________________~
Home Phone ___________ Cell Phone _________ Other Emergency _________
Length of Time at Previous
Name of the school where student is enrolled or in which student is attempting to enroll ____________
_ ~~__________ Last School Attended ______________Last District
Please check only one box that best describes where the student is presently living
o In my own home or apartment in Section 8 housing or in military housing with parent(s) legal guardian(s) or caregiver(s) (ifyou checked this box check one or both ofthe boxes below ifapplicable) (CODE=N)
o My home has no electricity (CODE=U)
o My home has no running water (CODE=U)
o In the home of a friend or relative because I lost my housing (examples fire flood lost job divorce domestic violence kicked out by parents parent in military and was deployed parent(s) injai etc (CODE=D)
o In a shelter becallse I do not have permanent hOllsing (examples living in a family shelter domestic violence shelter childrenyouth shelter FEMA housing) (CODE=S)
o In transitional housing (housing that is available for a specific length oftime only and is partly or completely paid for by a church a nonprofit organization or another organization) (CODE=S)
o In a hotel or motel (examples because ofeconomic hardship eviction cannot get deposits for permanent home floodfire hurricane efc) (CODE=HM)
o In a tent car van abandoned building on the streets at a campground in the park or other unsheltered location (CODE=U)
o None of the above describe my present living situation Briefly describe your situation _________~
Factors contributing to the students current living situation (check all that apply)
o Natural disaster
0 Tornado storm flood etc
o Hurricane name
o Fire prairie forest grass lightning strike etc
o Family issues such as divorce domestic violence kicked out by parents student left due to family conflict etc
o Home issues such as lack of electricity water heat adequate home repair due to lack of funds overcrowding mold etc
o Military Parentguardian deployed injured or killed in action
o Incarceration of parentguardian
o Incapacitation of parent or guardian due to health mental health drugsalcohol or other factors
o Home fire not due to natural causes (i e faulty equipmentappl iancesWiring furnace stove fireplace etc)
o Economic hardship
o Loss of job resulting in inability to pay rent or mortgage
o Income from part-time or low paying job does not cover cost of housing in the area
o Loss of mortgage including loss of mortgage of landlord if studentstudents family is renting
o Eviction record andor inability to produce deposits for rent or utilities
o High medical bills that leave little or no money for housing
o Lack of affordable housing in the area
o Minor student unable to afford housing on my own
o None of the above describe the main reasons for my present living situation Briefly explain the contributing factors _______________________________________
Please provide the following information for school-age siblings (brothers andor sisters) of the student
Name Grade Level School District
Signature of ParentLcgal GuardianCaregiverlUnaccompanied Student Date
For School Use Only I certify the above named student qualifies for the Child Nutrition Program under the provisions of the McKinney-Vento Act
McKinney-Vento Liaison Signature Date
New Student Information Conroe Independent School District
Creighton Elementary SchoolCampus _________________________________________________ Date ___________________
Students name _____~~__ ~____~__________ ~____~______ _______ __ ____ _0-______ Age ____
Date of birth ________ Grade _____ Student ID IImiddot ____ ____________
Has your child ever been enrolled in a Conroe Independent School District school before
1fyes name of school(s
Has your child ever repeated a
1fyes which grade(s)
Check Yes or No to indicate whe~er your child has ever received service~ in any of the following programs
Special Education including Speech
Special Reading or Math program (not in Special Education)
Migrant program
BilingualESL program
Gifted and Talented program
Section 504
Please note that official testing or other academic documentation may be required for your child to qualify in the Conroe Independent School District for any of the special programs marked Yes
FOR OFFICE ONLY
Entry
Teacher -__----------shy TRex
Cum Request _________
Info Updated _____ ___
lE1MS 706
Name of student (Nombre del estudiante) _______________________
Address (Domicilio)
ID (Numero de identificaci6n) _~____ Grade (Grado) ___
This fonn should be filled in and signed by parent or guardian for pre-kindergarten-8 students or by the student in grades 9-12 (Este formulari 0 debe completarlo y firmarlo el padremadre 0 tutor legal de los estudiantes que cursan los grados de prekindergarten a octavo 0 por el estudiante en los gmdos superiores)
Refer to Chapter 89 1215
What language is spoken in your home most of the time ~Cual es el idioma que mas se habla en su
What language does your child speak most of the time ~Cual es el idioma que mas habla su hijoa _________________
What language does your child speak and understand best zQue idioma habla y entiende mejor su hijoa _________________
Has your child lived outside the United States for two or more consecutive years zHa vivido su hijoa fuera de los Estados Unidos por dos 0 mas anos consecutivos C Yes No
How long has your child lived in the United States iCwinto tiempo ha vivido su hijoa en los Estados Unidos _________________
Has your sondaughter changed school districts within the last three years LSe ha cambiado su hljoa de distrito escolar durante los ultimos tres aiios 0 Yes 0 No
Did your child attend school regularly in the United States or in hisher native country LAsisti6 su hijoa con regularidad ala escuela en los Estados Unidos 0 palS nativo D Yes 0 No
Yes my child attended school regularly in the United States or in my country of origin and finished the previous grade Si mi hijoa asisti6 con regularidad ala escuela en los Estados Unidos 0 en mi pais de origen y termin6 el grado inmediato anterior
o No my child did not attend school regularly in the United States or in my country of origin and did not finish the previous grade as stated below (Specify the grade month and year your child failed to attend school Do not include if absences were less than a month) No mi hijoa no asisti6 con regularidad a la escuela en los Estados Unidos ni en mi pais de origen yno termin6 el grado inmediato anterior segun se especifica (Especifique el grado mes y ano cuando S1-l hijoa no asisti6 a la escuela No incluya este dato si falt6 a la escuela menos de un mes)
__-__---shy---------~----
Signature of parent (Firma del o tutor legal)
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Texas Education Agency Texas Public School StudenUStaff Ethnicity and Race Data Questionnaire
The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting thedata for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity Is the person HispanicLatino (Choose only one)
D HispanicLatino - A person of Cuban Mexican Puerto Rican South or Central American or other Spanish culture or origin regardless of race
D Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more)
D American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America) and who maintains a tribal affiliation or community attachment
D Asian - A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Philippine Islands Thailand and Vietnam
D Black or African American - A person having origins in any of the black racial groups of Africa
o Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii Guam Samoa or other Pacific Islands
o White - A person having origins in any of the original peoples of Europe the Middle East or North Africa
StudentlStaff Name (please print) (ParentlG uardian)(Staff) Signature
StudentlStaff Identification Number Date
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I
I
Conroe Independent School District (170902) Creighton Elementary School 106
Campus Namenumber
Students Legal Name Student ID
Please fill out the following information for all school in which this student was previously enrolled
Narne of Schoo1 School District School Numbers Dates of enrollment Grades (city amp State)
---~~~
-~~~
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middot ROE INDEPENDENT SCHOOL DISTRICT
(0 S Almiddotlt~L
This-free and reduced meal application is included in your Kindergarten packet to give you an opportunity to apply for free or reduced meals fell your student as heshe begins the 2014-15 school vea- at Conroe ISO By filling this out and submitting it our department can determine if yourrst~dent qualifies for the free or reduced lunch and if heshe qualifies can begin eating the
first day of schooL Please submit a new application next school year when you receive it because tltis application after approval is only good (or the first 30 days ofscltool Online applications are available and can be accessed through the Child Nutrition website We ENCOURAGE all families to apply on-line as this takes about twenty-Cour hours to process unless the student is not in the system yet The online application witl open the week of August 4h Parents can apply at wwwpplvforlunchcol11
Thank You Child Nutrition
Esta carta y la solicitud de comidas gratis 0 a precio reducido vienen dentro del paquete de inscripci6n al Jardin de Niflos (Kindergarten) para que usted pueda solicitar comidas gratis 0 a precio reducido para SlI estudiante durante el cicio escolar 2014-15 en Conroe ISD Una vez que usted entregue esta sol icitlld Ilena nuestro departamento podni determinar si SlI estudiante cllmple can los requisitos para recibir comidas gratis 0 a precio reducido En caso de que su
estudiante sea aprobado ellella podnl recibir com ida desde el primer dia de clases Nota Usted deberii lIenar V devolver una nueva solicitlld en cilanto la reciba al inicio del siguiente cicio escolar porque est primera solicitlld es temporal solamente sera valida dllrante los primeros 30 dias de clase (en ClISO de aber sido aprobada) Tambien podra lIenar la solicitud en linea Busquela en nllestra pagina electr6nica en el menLI PARENTS y luego en CHILD NUTRITION Invitamos a las familias a que tramitel1 su solicitud en lfnea debido a que este tnil11ite solamente dura 24 horas a menos que el estudiante no este dado de alta en el sistema La opci6n de presentar Ia solicitud en linea se abrira durante la semana del4 de agosto Los padres podran tramitar su solicitud en wwwapplyforlul1chcom
Atentamente Departamento de Nutrici6n Infantil
2015 -2016 1--middotmiddotFamilv Survev I Campus name Campus Conroe ISO -170902 L-I---------------- shy
N arne of child ---------------____-------shy
Grade level ---__ - Date
Dear Parents
In order to better serve your children the school district would like to identify students who may qualify to receive additional educational services The information provided below will be kept confidential Please answer the following questions and return this survey to your childs school
Please provide the following information (Only if yes was answered to questions 1 amp 2 above)
Name of child ____ _ ___ Age ___ Grade ___
Father Guardian ~__ __~__~__________________~_ _____________~
Mother Guardian _ _________
Street City State Zip
Home Telephone Number __ _____~
Other Phone _____ bull--- ------ ------- shy
The Conroe Independent Schoo District does not discriminate on the basis ot race color naUana origin sex disability or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups The followlng persons have been designated to handle inquiries regatdlng these non-discrimination pofiCies
l1na IX Coordinator 3205 W Davis COnroe Texas 77304 (936l-709~7700 and the Section 504ADA Coordinator 3205 W Oavis Conroe Texas 77304 (936) 709middot7670
Community Outreach and Dropout Prevention Rodrigo Chaves DirectorNROE
INDEPENDENT SCHOOL DISTRICT 3205 West Davis bull Conroe Texas 77304-2098 ~to-amp~ 9367097759
bull bull
Conroe Independent School District 2015-2016 Application for Free and Reduced Price School Meals Return to the school cafeteria manager or mail to the Conroe ISO Child Nutrition Department
bull Use black ink Print neatly Complete one application per household 3205 West Davis Conroe TX 77302-2098
~ List ALL household members who are infants children and students up to and including grade 12 (If more space is required for additional names attach another sheet ofpaper) Homeloss
Brthdate School roster migrant Legal first name MI Legal last name MM DO yy Grade Code Child runaway
Definition of Household Member Anyone who is living with you and shares income and expenses even if not related
Children in foster care and children who meet the definition of Homeless Migrant or Runaway are eligible for free meals Read How to Apply for Free and Reduced Price School Meals for more information
~ Do any Household Members (including you) currently participate in one or more of the following assistance programs SNAP TANF FDPIR Check the appropriate box below
If you did not check one of the boxes If you Checked one of the boxes to the left write EDG number here
SNAP TANF FDPIR to the leI conplete SECTION 3 then go to SECTiON 4 (Do Not complete SECTION 3) EDG number ~ Report income for ALL Household Members (skip this step if you answered yes to SECTION 2)
A Child Income Sometimes children in the household earn income Please indicate the TOTAL income earned by all Household Members in SECTION 1 here Child income
B All Adult Household Members (including yourself) List all Household Members not listed in SECTION 1 (including yourself) even if they did not receive income For each Household Member listed if they receive income report total income for each source in whole dollars ONLY If they Do Not receive income from any WET M source check the no income box If you check the no income box yu are certifying (promising) that there is no income to report
W = Weekly E Every two weeks T Twice per month M Monthly A = Annually Public Assistance
Name of Adult Household Member (first and last) Earnings from work Fill In circle Child SupporVAlimony Fill in circleI I Please read How to 81 Apply for Free and Reduced Price School Meals for more information The Sources of Income for Children section will help
lEC ryou wijh the Child Income questions The Sources of Income for Adults section will help you with EMJ the All Adult Household Members section
bull Write total number of Household Members here Last four digits of Social Security Number (SSN)
~ Contact Information and Adult Signature I certify (promise) that all infmation on this application is true and that all income is reported I understand that this information is given in connection with the receipt of Federal funds and that school officials may verify (check) the information I am aware that if I purposely give false information my children may lose meal benefits and I may be prosecuted under applicable State and Federal laws Street address Zip Daytime phone
~-~T-T---~r---~r------------------~ ~~--- i
bull Do not fill out this part For school use only Printed name of adult completing this form xsign here Todays date
Received Reviewing officials signature Date Confirming officials Signature _ Date FollOW-Up officials signature Date
~ --~~~~~~~------
Printed name ofstuqent
Signature ofstudent
Signature ofparent
~~ --~
Date
INDEPENDENT SCHOOL DISTRICT
~to-amp~
Nombre del alumno (tetra de molde)
FIrma del alumno
Finna del padre
Fecha
I unders+anc I wilt haJ~ to pick +hi~ Ll~ -frOYl the- -9r0nt office yo emendD qyc de-bo
de leC0cter eS+Gl COplCV d~ let ofc-incc prinCipal
Dear Pltlrent or Guardian
Throughout the year different orgmizations come to Creighton Elementary wanting to assist our shldents and families with school supplies clothing and other various needs The Family Educational Rights and privacy Act a federal law that make student educational records confidentiat prohibits us from releltlsing student information to these ltlgencies without your permission Tb help us work with these groups in the most efficient way possible we ask that if you are interested in such assistance you complete and sign the form below The form should be rehlmed to Susan Fossler
These assistance programs vary from year to year Giving us permission to release your information does not automatically mean vou will receive assistance It does let ~tS knmj that you would welcome such assistance and would be willing to have your information released to these orgaJ~izations In turn these groups agree to use your information only for the purpose of their assistance program(s) It is also required that your consent for release of information be updated annually If you have a question feel free to contact your childs counselor
Sincerely
Jenny Watson Principal
Shldent name Nomlm dd (studiallte _
Parents names Nombre dc padre 0 cllcl1Ixado __
AddressDirccci611
Phone Tcitfi)ffo
Are there siblings ~Ticllc hermallitos i_- yes sl no noJ
Estimado Padre de Familia 0 encargado
Durante el ano diferentes organizaciones vienen a la escuela Creighton Elementary con eJ objetivo de
ayudar a nuestros estudiantes y sus familia res con utiles escolares ropa y otras necesidades
El Acto de Privacidad y Derechos Educacionales de la Familia una ley federal que hace que los archivos e historial educativo del eshldiante sean confidenciales nos prohibe que divulguemos informacion de estudiantes a tales organizaciones sin e1
permiso suyo Para que nos ayude a trabajar y cooperltlr con esas organizaciones de la manera
mas eficiente Ie pedimos que si LIsted esta interesado (a) en recibir dicho tipo de asistencia 0
ayuda que complete y firme la forma abajo Esta forma la debe de regresar a Susan Fossler
Estos programas de asistencia varian de ano a ano El que nos autorice a dar el permiso pedido no signifiea que recibira ayuda automaticamente Lo que nos indica es que LJsted esta dispuesto (a) a recibir dicha asistencia y que acepta que la informacion suya sea compartida con esas organizaciones Esto pennite a que estos grupos y organizaciones acuerden usar dicha informacion soJamente para e1 prop6sito del program de asistencia Tambien se requiere que renueve este permiso de divulgaci6n de informacion anualmente Si tiene alguna pregunta contacte al consejero (a) de su hijo (a)
Sincerely
Jenny Watson Prillcipal
If yes names and ages of siblings I Nomnc y cdad de los hCrl11111 itos
Parent signature Firma del padre Date I Fecha
Middle Last
Street Name Zip Code
I Mailing Address If different from
above Street Name City Zip
STUDENT RESIDES WITH
Circle One
Step Mother Step Father
J Guardianother Guardianother~ t i t I
Full Name i
Cell Phone Number
bull Work Number
Place of employment
IEmail Address
bullbullbullbullbullbullbullbullbullbullbull eow th hld er Ivm~ WItL1st b I e names 0 f any C 1 ren un d 18myour amlly or r h your famity
Name Age Grade In what school I
Student name
Campus
Military Connected Student Information
State law requires school districts to collect data related to students with connections to the military
Complete and return this form only if your child meets one of the following criteria
Student is a dependent of an Active Duty member of the United States military (Army NatY Air Force lvlarine Corps or Coast Guard)
Student is a dependent of a member of the Texas National Guard (Army Air Guard or State Guard)
Student is a dependent of a member of the reserve force in the United States military (AmlY Navy Marine Corps Coast Guard)
Pre-kindergarten student is a dependent of
1 An active duty uniformed member of the United States military (Army Navy Air Force 1vlarine Corps or Coast Guard)
2 An activatedmobilized uniformed member of the Texas National Guard (Army Air Guard or State Guard)
3 An activatedmobilized member of the United States reserve (Army Navy lvIarine Corps Air Force or Coast Guard)
4 Member of the United States military or reserve or Texas National Guard who was injured or killed while serving on active duty
ID number
Grade
Foster Care Status Information
State law requires school districts to collect data related to students who currently are in or have been in foster care under certain circumstances
Complete and return this form only if your child meets one of the following criteria
Student is currently in the conservatorship of the Department of Family and Protective Services
i J Pre-kindergarten student was previously in the conservatorship of the Department of Family and Protective Services following an adversary hearing held as provided by Section 262201 Family Code
PalelltGuardillll signaWI Dale
Cq~r SCOOlDiSTRICT ~~uZ~
---------
Parents Please complete back of form (page 2) Teacher check one r No-show lirst ~
ICONROEINDEPENDENT Registration Form - New Students ISCHOOL DISTRICT
~~---
106Campus No 1 70902
Creighton Elementary SchoolCampus
last
Sex ______ Birth Date ~__~__~_~___ __Student ID
Student resides with Omother Ofather
Phone (home) ~___~__~__ (workL--- ___~____
Guardian Email addresses ---~----~-----------------------------------~-----------------~-
Students Physical Address _________ ------- --- shy-----------~ street address city zip
Street address city zip
Other parentguardian information if applicable
Name _________~_____________ ______________ Phone (home) ____~~__~ _ (worki_ _ ____~___
Physical Address ________~__ ----------~ street address city zip
Other ParentGuardian Email addresses __~_______________________
Warning It is a criminal offense pursuant to Texas Penal Code 3710 for a person to knowingly falsify information on a form required for a students enrollment in the District This is such a form
Parentguardian signature required for enrollment ofstudent Si es necesario por favor pedir la forma en espano
I am aware that in order for my child to attend school in the Conroe lSD my child must meet the districts residency requirements or be granted an approved Interdistrict transfer I acknowledge that 1have read and understand the penalties of falsified information as stated in the Texas Education Code sect25001 (h) printed below I also agree to inform the proper school authorities immediately should I move from the address indicated Proof of residency is required
Texas Education Code sect25001 h In addition to the penalty provided by sect3 71 0 of the Penal Code a person who knowingly falsifies information on a form required for
enrollment of a student in a school district is liable to the district if the student is not eligible for enrollment in the district but is enrolled on the basis of the false information The person is liable for the period during which the ineligible student is enrolled for the greater of
1) the maximum tuition fee the district may charge under sect25038 of this code or 2) the amount the district has budgeted for each student as maintenance and operating expenses
I hereby certify one of the following a)primary guardian is a resident (managing conservator or legal guardians) blother legal parent is a resident (possessory conservator) clstudent signing form is at least 18 years of age and a resident of the district or d)student has been granted an approved Interdstrct transfer I understand that one of these conditions must be maintained in order for the student to attend the Conroe ISO I also agree to inform the proper school authorities immediately should Imove from the address indicated above
With my signature I acknowledge that I have read and verify the information on this registration form and that I understand the penalties of providing falsified information as stated above
ParentGuardian Signature Date
In order to meet Texas Education Agencys recommended guidelines (ISO is using social security numbers for the required PEIMS Reporting Number If you choose not to provide this information please provide the Districts Legal Department with written objection within ten days of the issuance of this notice
The Conroe Independent School District does not discriminate on the basis of race color national origin sex religion age or disability in its admissiOns policies or by excluding from participation in denying access to or denying the benefits of district services academic andor vocational and technology programs or activities as required by Title VI and Title VII of the CiVil Rights Act of 1964 as amended Title IX of the Education Amendments of 1972 the First Amendment of the United States Constitution the Age Discrimination Act of 1975 Section 504 of the Rehabilitation Act of 1973 as amended and Title of the Americans with Disabilities Act
For information about Title IX rights contact the Title IX Coordinator 3205 W Davis Conroe Texas 77304 (936)709-7700 For information about Section S04ADA rights contact the Section 504ADA Coordinator 3205 W Davis Conroe Texas 77304 (936)709middot7670
Parents should forward any medical information allergies or medical problems to the attention of the campus ~J
Administrative Enrollment
Administrator or DiagnosticianSpeech Therapists signatureltitle Date PEIMS (410) front (page 1)
-----
---- ---- ------
Bus No
School Bus Registration Form
Please complete the following information to ensure access to transportation services Vithollt prior registration your student lIIay not be able to ride the school bus until proper registration has bccn received by the Transportation Department
(Please print)
Date Campus Creighton Elementary School
Students name Student ID
Will student be riding the bus this year (Place an X in the appropriate box)
Always Sometimes No
shy
Complete the student information below ONLY if your student will need to ride the school bus
Birthdate Age Sex Grade -~---~
Home address
Phone (HomeCell) _--_-------shy
ParentGuardian name
ParentGuardian work phone
Emergency Contact (when parent or guardian can not be rcached)
)Jame Relationship to student
Address ----- --------------------- ---_----- _----shy
Phone )Jumbers ----------------------_--------- _-shy
ParentGuardian Signature
Conloe Independent School District Student Residency Questionnaire
The information on this form is required to meet the law known as the McKinney-Vento Act 42 USc 11434a(2) which is also known as Title X Part C of the No Child Left Behind Act The answers you give will help the school determine the services the student may be eligible to receive
Presenting a false record or falsifying records is an offense IInder Section 37 JO Penal code and enrollment of the child under false documents subjects the person 10 liability for tuition or other costs TEe Sec 25 002 (3)(d)
Name of Student ___________----_______________ Gender 0 Male 0 Female
Last First Middle
Birth Date __-----_--_ CampusCreighton Elementary Grade ____ Student Month Day Year
Check the box that best describes with whom the student resides (Please note legal guardianship may be granted only by a court students living on their own or with friends or relatives who do not have legal guardianship are allowed to enroll in and attend schoo The school cannot require proofofguardianship for enrollment or continued attendance)
o Parent(s)
o Legal Guardians(s)
o Caregiver(s) who are not legal guardian(s) (Examples friends relatives parents offriends etc) o Other _________________________________________________________________
Name of person with whom student resides ___________________________~
Home Phone ___________ Cell Phone _________ Other Emergency _________
Length of Time at Previous
Name of the school where student is enrolled or in which student is attempting to enroll ____________
_ ~~__________ Last School Attended ______________Last District
Please check only one box that best describes where the student is presently living
o In my own home or apartment in Section 8 housing or in military housing with parent(s) legal guardian(s) or caregiver(s) (ifyou checked this box check one or both ofthe boxes below ifapplicable) (CODE=N)
o My home has no electricity (CODE=U)
o My home has no running water (CODE=U)
o In the home of a friend or relative because I lost my housing (examples fire flood lost job divorce domestic violence kicked out by parents parent in military and was deployed parent(s) injai etc (CODE=D)
o In a shelter becallse I do not have permanent hOllsing (examples living in a family shelter domestic violence shelter childrenyouth shelter FEMA housing) (CODE=S)
o In transitional housing (housing that is available for a specific length oftime only and is partly or completely paid for by a church a nonprofit organization or another organization) (CODE=S)
o In a hotel or motel (examples because ofeconomic hardship eviction cannot get deposits for permanent home floodfire hurricane efc) (CODE=HM)
o In a tent car van abandoned building on the streets at a campground in the park or other unsheltered location (CODE=U)
o None of the above describe my present living situation Briefly describe your situation _________~
Factors contributing to the students current living situation (check all that apply)
o Natural disaster
0 Tornado storm flood etc
o Hurricane name
o Fire prairie forest grass lightning strike etc
o Family issues such as divorce domestic violence kicked out by parents student left due to family conflict etc
o Home issues such as lack of electricity water heat adequate home repair due to lack of funds overcrowding mold etc
o Military Parentguardian deployed injured or killed in action
o Incarceration of parentguardian
o Incapacitation of parent or guardian due to health mental health drugsalcohol or other factors
o Home fire not due to natural causes (i e faulty equipmentappl iancesWiring furnace stove fireplace etc)
o Economic hardship
o Loss of job resulting in inability to pay rent or mortgage
o Income from part-time or low paying job does not cover cost of housing in the area
o Loss of mortgage including loss of mortgage of landlord if studentstudents family is renting
o Eviction record andor inability to produce deposits for rent or utilities
o High medical bills that leave little or no money for housing
o Lack of affordable housing in the area
o Minor student unable to afford housing on my own
o None of the above describe the main reasons for my present living situation Briefly explain the contributing factors _______________________________________
Please provide the following information for school-age siblings (brothers andor sisters) of the student
Name Grade Level School District
Signature of ParentLcgal GuardianCaregiverlUnaccompanied Student Date
For School Use Only I certify the above named student qualifies for the Child Nutrition Program under the provisions of the McKinney-Vento Act
McKinney-Vento Liaison Signature Date
New Student Information Conroe Independent School District
Creighton Elementary SchoolCampus _________________________________________________ Date ___________________
Students name _____~~__ ~____~__________ ~____~______ _______ __ ____ _0-______ Age ____
Date of birth ________ Grade _____ Student ID IImiddot ____ ____________
Has your child ever been enrolled in a Conroe Independent School District school before
1fyes name of school(s
Has your child ever repeated a
1fyes which grade(s)
Check Yes or No to indicate whe~er your child has ever received service~ in any of the following programs
Special Education including Speech
Special Reading or Math program (not in Special Education)
Migrant program
BilingualESL program
Gifted and Talented program
Section 504
Please note that official testing or other academic documentation may be required for your child to qualify in the Conroe Independent School District for any of the special programs marked Yes
FOR OFFICE ONLY
Entry
Teacher -__----------shy TRex
Cum Request _________
Info Updated _____ ___
lE1MS 706
Name of student (Nombre del estudiante) _______________________
Address (Domicilio)
ID (Numero de identificaci6n) _~____ Grade (Grado) ___
This fonn should be filled in and signed by parent or guardian for pre-kindergarten-8 students or by the student in grades 9-12 (Este formulari 0 debe completarlo y firmarlo el padremadre 0 tutor legal de los estudiantes que cursan los grados de prekindergarten a octavo 0 por el estudiante en los gmdos superiores)
Refer to Chapter 89 1215
What language is spoken in your home most of the time ~Cual es el idioma que mas se habla en su
What language does your child speak most of the time ~Cual es el idioma que mas habla su hijoa _________________
What language does your child speak and understand best zQue idioma habla y entiende mejor su hijoa _________________
Has your child lived outside the United States for two or more consecutive years zHa vivido su hijoa fuera de los Estados Unidos por dos 0 mas anos consecutivos C Yes No
How long has your child lived in the United States iCwinto tiempo ha vivido su hijoa en los Estados Unidos _________________
Has your sondaughter changed school districts within the last three years LSe ha cambiado su hljoa de distrito escolar durante los ultimos tres aiios 0 Yes 0 No
Did your child attend school regularly in the United States or in hisher native country LAsisti6 su hijoa con regularidad ala escuela en los Estados Unidos 0 palS nativo D Yes 0 No
Yes my child attended school regularly in the United States or in my country of origin and finished the previous grade Si mi hijoa asisti6 con regularidad ala escuela en los Estados Unidos 0 en mi pais de origen y termin6 el grado inmediato anterior
o No my child did not attend school regularly in the United States or in my country of origin and did not finish the previous grade as stated below (Specify the grade month and year your child failed to attend school Do not include if absences were less than a month) No mi hijoa no asisti6 con regularidad a la escuela en los Estados Unidos ni en mi pais de origen yno termin6 el grado inmediato anterior segun se especifica (Especifique el grado mes y ano cuando S1-l hijoa no asisti6 a la escuela No incluya este dato si falt6 a la escuela menos de un mes)
__-__---shy---------~----
Signature of parent (Firma del o tutor legal)
CISDmiddot17 (9111) White copymiddot Cumulative Folder Yellow copymiddot Green Foldermiddot Pink copy AI-risk Counselor lCavh~t~OI~lonQ IVI_~~pl)oamprcI~XJIIrvt~ltrtt1lII_apy~J 81IJ1ltn-Irf~ptC9 UocUgtJI II-laquoJ~IIIlaquon ~mgtIlOYInD-eoJtrylliloVlTnoWiJCflylt~(J~o cdod
ToIXctIhooE~~d 15n a~~Ogtt~_d 1915 fndS ~d II_411mdlfrau-_ta ~n~ _~ aorlJdlytlor--shy
i[Mtf~~_c(prPflais ~IWP~__~_fOlpVN~~~~ c~VI~_~lIk1OatJltf__dillcJ~_~ovou_tJo~ltJo _ fJ~$If~~ _ IN~ IIOQIIQul_ffir_Yl rl__ W~kbodl~ClWn I64 f __bull rlMoalthgtliltspound~1L-u_ ~T_ ooIl4da~f_ 19 ~ soamp5()iltM~~ 191) _~_tu~ltUOO ~u_CltI~p
Texas Education Agency Texas Public School StudenUStaff Ethnicity and Race Data Questionnaire
The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting thedata for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity Is the person HispanicLatino (Choose only one)
D HispanicLatino - A person of Cuban Mexican Puerto Rican South or Central American or other Spanish culture or origin regardless of race
D Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more)
D American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America) and who maintains a tribal affiliation or community attachment
D Asian - A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Philippine Islands Thailand and Vietnam
D Black or African American - A person having origins in any of the black racial groups of Africa
o Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii Guam Samoa or other Pacific Islands
o White - A person having origins in any of the original peoples of Europe the Middle East or North Africa
StudentlStaff Name (please print) (ParentlG uardian)(Staff) Signature
StudentlStaff Identification Number Date
-----
-------
----
I
I
Conroe Independent School District (170902) Creighton Elementary School 106
Campus Namenumber
Students Legal Name Student ID
Please fill out the following information for all school in which this student was previously enrolled
Narne of Schoo1 School District School Numbers Dates of enrollment Grades (city amp State)
---~~~
-~~~
~~~~~
middot ROE INDEPENDENT SCHOOL DISTRICT
(0 S Almiddotlt~L
This-free and reduced meal application is included in your Kindergarten packet to give you an opportunity to apply for free or reduced meals fell your student as heshe begins the 2014-15 school vea- at Conroe ISO By filling this out and submitting it our department can determine if yourrst~dent qualifies for the free or reduced lunch and if heshe qualifies can begin eating the
first day of schooL Please submit a new application next school year when you receive it because tltis application after approval is only good (or the first 30 days ofscltool Online applications are available and can be accessed through the Child Nutrition website We ENCOURAGE all families to apply on-line as this takes about twenty-Cour hours to process unless the student is not in the system yet The online application witl open the week of August 4h Parents can apply at wwwpplvforlunchcol11
Thank You Child Nutrition
Esta carta y la solicitud de comidas gratis 0 a precio reducido vienen dentro del paquete de inscripci6n al Jardin de Niflos (Kindergarten) para que usted pueda solicitar comidas gratis 0 a precio reducido para SlI estudiante durante el cicio escolar 2014-15 en Conroe ISD Una vez que usted entregue esta sol icitlld Ilena nuestro departamento podni determinar si SlI estudiante cllmple can los requisitos para recibir comidas gratis 0 a precio reducido En caso de que su
estudiante sea aprobado ellella podnl recibir com ida desde el primer dia de clases Nota Usted deberii lIenar V devolver una nueva solicitlld en cilanto la reciba al inicio del siguiente cicio escolar porque est primera solicitlld es temporal solamente sera valida dllrante los primeros 30 dias de clase (en ClISO de aber sido aprobada) Tambien podra lIenar la solicitud en linea Busquela en nllestra pagina electr6nica en el menLI PARENTS y luego en CHILD NUTRITION Invitamos a las familias a que tramitel1 su solicitud en lfnea debido a que este tnil11ite solamente dura 24 horas a menos que el estudiante no este dado de alta en el sistema La opci6n de presentar Ia solicitud en linea se abrira durante la semana del4 de agosto Los padres podran tramitar su solicitud en wwwapplyforlul1chcom
Atentamente Departamento de Nutrici6n Infantil
2015 -2016 1--middotmiddotFamilv Survev I Campus name Campus Conroe ISO -170902 L-I---------------- shy
N arne of child ---------------____-------shy
Grade level ---__ - Date
Dear Parents
In order to better serve your children the school district would like to identify students who may qualify to receive additional educational services The information provided below will be kept confidential Please answer the following questions and return this survey to your childs school
Please provide the following information (Only if yes was answered to questions 1 amp 2 above)
Name of child ____ _ ___ Age ___ Grade ___
Father Guardian ~__ __~__~__________________~_ _____________~
Mother Guardian _ _________
Street City State Zip
Home Telephone Number __ _____~
Other Phone _____ bull--- ------ ------- shy
The Conroe Independent Schoo District does not discriminate on the basis ot race color naUana origin sex disability or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups The followlng persons have been designated to handle inquiries regatdlng these non-discrimination pofiCies
l1na IX Coordinator 3205 W Davis COnroe Texas 77304 (936l-709~7700 and the Section 504ADA Coordinator 3205 W Oavis Conroe Texas 77304 (936) 709middot7670
Community Outreach and Dropout Prevention Rodrigo Chaves DirectorNROE
INDEPENDENT SCHOOL DISTRICT 3205 West Davis bull Conroe Texas 77304-2098 ~to-amp~ 9367097759
bull bull
Conroe Independent School District 2015-2016 Application for Free and Reduced Price School Meals Return to the school cafeteria manager or mail to the Conroe ISO Child Nutrition Department
bull Use black ink Print neatly Complete one application per household 3205 West Davis Conroe TX 77302-2098
~ List ALL household members who are infants children and students up to and including grade 12 (If more space is required for additional names attach another sheet ofpaper) Homeloss
Brthdate School roster migrant Legal first name MI Legal last name MM DO yy Grade Code Child runaway
Definition of Household Member Anyone who is living with you and shares income and expenses even if not related
Children in foster care and children who meet the definition of Homeless Migrant or Runaway are eligible for free meals Read How to Apply for Free and Reduced Price School Meals for more information
~ Do any Household Members (including you) currently participate in one or more of the following assistance programs SNAP TANF FDPIR Check the appropriate box below
If you did not check one of the boxes If you Checked one of the boxes to the left write EDG number here
SNAP TANF FDPIR to the leI conplete SECTION 3 then go to SECTiON 4 (Do Not complete SECTION 3) EDG number ~ Report income for ALL Household Members (skip this step if you answered yes to SECTION 2)
A Child Income Sometimes children in the household earn income Please indicate the TOTAL income earned by all Household Members in SECTION 1 here Child income
B All Adult Household Members (including yourself) List all Household Members not listed in SECTION 1 (including yourself) even if they did not receive income For each Household Member listed if they receive income report total income for each source in whole dollars ONLY If they Do Not receive income from any WET M source check the no income box If you check the no income box yu are certifying (promising) that there is no income to report
W = Weekly E Every two weeks T Twice per month M Monthly A = Annually Public Assistance
Name of Adult Household Member (first and last) Earnings from work Fill In circle Child SupporVAlimony Fill in circleI I Please read How to 81 Apply for Free and Reduced Price School Meals for more information The Sources of Income for Children section will help
lEC ryou wijh the Child Income questions The Sources of Income for Adults section will help you with EMJ the All Adult Household Members section
bull Write total number of Household Members here Last four digits of Social Security Number (SSN)
~ Contact Information and Adult Signature I certify (promise) that all infmation on this application is true and that all income is reported I understand that this information is given in connection with the receipt of Federal funds and that school officials may verify (check) the information I am aware that if I purposely give false information my children may lose meal benefits and I may be prosecuted under applicable State and Federal laws Street address Zip Daytime phone
~-~T-T---~r---~r------------------~ ~~--- i
bull Do not fill out this part For school use only Printed name of adult completing this form xsign here Todays date
Received Reviewing officials signature Date Confirming officials Signature _ Date FollOW-Up officials signature Date
~ --~~~~~~~------
Printed name ofstuqent
Signature ofstudent
Signature ofparent
~~ --~
Date
INDEPENDENT SCHOOL DISTRICT
~to-amp~
Nombre del alumno (tetra de molde)
FIrma del alumno
Finna del padre
Fecha
I unders+anc I wilt haJ~ to pick +hi~ Ll~ -frOYl the- -9r0nt office yo emendD qyc de-bo
de leC0cter eS+Gl COplCV d~ let ofc-incc prinCipal
Dear Pltlrent or Guardian
Throughout the year different orgmizations come to Creighton Elementary wanting to assist our shldents and families with school supplies clothing and other various needs The Family Educational Rights and privacy Act a federal law that make student educational records confidentiat prohibits us from releltlsing student information to these ltlgencies without your permission Tb help us work with these groups in the most efficient way possible we ask that if you are interested in such assistance you complete and sign the form below The form should be rehlmed to Susan Fossler
These assistance programs vary from year to year Giving us permission to release your information does not automatically mean vou will receive assistance It does let ~tS knmj that you would welcome such assistance and would be willing to have your information released to these orgaJ~izations In turn these groups agree to use your information only for the purpose of their assistance program(s) It is also required that your consent for release of information be updated annually If you have a question feel free to contact your childs counselor
Sincerely
Jenny Watson Principal
Shldent name Nomlm dd (studiallte _
Parents names Nombre dc padre 0 cllcl1Ixado __
AddressDirccci611
Phone Tcitfi)ffo
Are there siblings ~Ticllc hermallitos i_- yes sl no noJ
Estimado Padre de Familia 0 encargado
Durante el ano diferentes organizaciones vienen a la escuela Creighton Elementary con eJ objetivo de
ayudar a nuestros estudiantes y sus familia res con utiles escolares ropa y otras necesidades
El Acto de Privacidad y Derechos Educacionales de la Familia una ley federal que hace que los archivos e historial educativo del eshldiante sean confidenciales nos prohibe que divulguemos informacion de estudiantes a tales organizaciones sin e1
permiso suyo Para que nos ayude a trabajar y cooperltlr con esas organizaciones de la manera
mas eficiente Ie pedimos que si LIsted esta interesado (a) en recibir dicho tipo de asistencia 0
ayuda que complete y firme la forma abajo Esta forma la debe de regresar a Susan Fossler
Estos programas de asistencia varian de ano a ano El que nos autorice a dar el permiso pedido no signifiea que recibira ayuda automaticamente Lo que nos indica es que LJsted esta dispuesto (a) a recibir dicha asistencia y que acepta que la informacion suya sea compartida con esas organizaciones Esto pennite a que estos grupos y organizaciones acuerden usar dicha informacion soJamente para e1 prop6sito del program de asistencia Tambien se requiere que renueve este permiso de divulgaci6n de informacion anualmente Si tiene alguna pregunta contacte al consejero (a) de su hijo (a)
Sincerely
Jenny Watson Prillcipal
If yes names and ages of siblings I Nomnc y cdad de los hCrl11111 itos
Parent signature Firma del padre Date I Fecha
Student name
Campus
Military Connected Student Information
State law requires school districts to collect data related to students with connections to the military
Complete and return this form only if your child meets one of the following criteria
Student is a dependent of an Active Duty member of the United States military (Army NatY Air Force lvlarine Corps or Coast Guard)
Student is a dependent of a member of the Texas National Guard (Army Air Guard or State Guard)
Student is a dependent of a member of the reserve force in the United States military (AmlY Navy Marine Corps Coast Guard)
Pre-kindergarten student is a dependent of
1 An active duty uniformed member of the United States military (Army Navy Air Force 1vlarine Corps or Coast Guard)
2 An activatedmobilized uniformed member of the Texas National Guard (Army Air Guard or State Guard)
3 An activatedmobilized member of the United States reserve (Army Navy lvIarine Corps Air Force or Coast Guard)
4 Member of the United States military or reserve or Texas National Guard who was injured or killed while serving on active duty
ID number
Grade
Foster Care Status Information
State law requires school districts to collect data related to students who currently are in or have been in foster care under certain circumstances
Complete and return this form only if your child meets one of the following criteria
Student is currently in the conservatorship of the Department of Family and Protective Services
i J Pre-kindergarten student was previously in the conservatorship of the Department of Family and Protective Services following an adversary hearing held as provided by Section 262201 Family Code
PalelltGuardillll signaWI Dale
Cq~r SCOOlDiSTRICT ~~uZ~
---------
Parents Please complete back of form (page 2) Teacher check one r No-show lirst ~
ICONROEINDEPENDENT Registration Form - New Students ISCHOOL DISTRICT
~~---
106Campus No 1 70902
Creighton Elementary SchoolCampus
last
Sex ______ Birth Date ~__~__~_~___ __Student ID
Student resides with Omother Ofather
Phone (home) ~___~__~__ (workL--- ___~____
Guardian Email addresses ---~----~-----------------------------------~-----------------~-
Students Physical Address _________ ------- --- shy-----------~ street address city zip
Street address city zip
Other parentguardian information if applicable
Name _________~_____________ ______________ Phone (home) ____~~__~ _ (worki_ _ ____~___
Physical Address ________~__ ----------~ street address city zip
Other ParentGuardian Email addresses __~_______________________
Warning It is a criminal offense pursuant to Texas Penal Code 3710 for a person to knowingly falsify information on a form required for a students enrollment in the District This is such a form
Parentguardian signature required for enrollment ofstudent Si es necesario por favor pedir la forma en espano
I am aware that in order for my child to attend school in the Conroe lSD my child must meet the districts residency requirements or be granted an approved Interdistrict transfer I acknowledge that 1have read and understand the penalties of falsified information as stated in the Texas Education Code sect25001 (h) printed below I also agree to inform the proper school authorities immediately should I move from the address indicated Proof of residency is required
Texas Education Code sect25001 h In addition to the penalty provided by sect3 71 0 of the Penal Code a person who knowingly falsifies information on a form required for
enrollment of a student in a school district is liable to the district if the student is not eligible for enrollment in the district but is enrolled on the basis of the false information The person is liable for the period during which the ineligible student is enrolled for the greater of
1) the maximum tuition fee the district may charge under sect25038 of this code or 2) the amount the district has budgeted for each student as maintenance and operating expenses
I hereby certify one of the following a)primary guardian is a resident (managing conservator or legal guardians) blother legal parent is a resident (possessory conservator) clstudent signing form is at least 18 years of age and a resident of the district or d)student has been granted an approved Interdstrct transfer I understand that one of these conditions must be maintained in order for the student to attend the Conroe ISO I also agree to inform the proper school authorities immediately should Imove from the address indicated above
With my signature I acknowledge that I have read and verify the information on this registration form and that I understand the penalties of providing falsified information as stated above
ParentGuardian Signature Date
In order to meet Texas Education Agencys recommended guidelines (ISO is using social security numbers for the required PEIMS Reporting Number If you choose not to provide this information please provide the Districts Legal Department with written objection within ten days of the issuance of this notice
The Conroe Independent School District does not discriminate on the basis of race color national origin sex religion age or disability in its admissiOns policies or by excluding from participation in denying access to or denying the benefits of district services academic andor vocational and technology programs or activities as required by Title VI and Title VII of the CiVil Rights Act of 1964 as amended Title IX of the Education Amendments of 1972 the First Amendment of the United States Constitution the Age Discrimination Act of 1975 Section 504 of the Rehabilitation Act of 1973 as amended and Title of the Americans with Disabilities Act
For information about Title IX rights contact the Title IX Coordinator 3205 W Davis Conroe Texas 77304 (936)709-7700 For information about Section S04ADA rights contact the Section 504ADA Coordinator 3205 W Davis Conroe Texas 77304 (936)709middot7670
Parents should forward any medical information allergies or medical problems to the attention of the campus ~J
Administrative Enrollment
Administrator or DiagnosticianSpeech Therapists signatureltitle Date PEIMS (410) front (page 1)
-----
---- ---- ------
Bus No
School Bus Registration Form
Please complete the following information to ensure access to transportation services Vithollt prior registration your student lIIay not be able to ride the school bus until proper registration has bccn received by the Transportation Department
(Please print)
Date Campus Creighton Elementary School
Students name Student ID
Will student be riding the bus this year (Place an X in the appropriate box)
Always Sometimes No
shy
Complete the student information below ONLY if your student will need to ride the school bus
Birthdate Age Sex Grade -~---~
Home address
Phone (HomeCell) _--_-------shy
ParentGuardian name
ParentGuardian work phone
Emergency Contact (when parent or guardian can not be rcached)
)Jame Relationship to student
Address ----- --------------------- ---_----- _----shy
Phone )Jumbers ----------------------_--------- _-shy
ParentGuardian Signature
Conloe Independent School District Student Residency Questionnaire
The information on this form is required to meet the law known as the McKinney-Vento Act 42 USc 11434a(2) which is also known as Title X Part C of the No Child Left Behind Act The answers you give will help the school determine the services the student may be eligible to receive
Presenting a false record or falsifying records is an offense IInder Section 37 JO Penal code and enrollment of the child under false documents subjects the person 10 liability for tuition or other costs TEe Sec 25 002 (3)(d)
Name of Student ___________----_______________ Gender 0 Male 0 Female
Last First Middle
Birth Date __-----_--_ CampusCreighton Elementary Grade ____ Student Month Day Year
Check the box that best describes with whom the student resides (Please note legal guardianship may be granted only by a court students living on their own or with friends or relatives who do not have legal guardianship are allowed to enroll in and attend schoo The school cannot require proofofguardianship for enrollment or continued attendance)
o Parent(s)
o Legal Guardians(s)
o Caregiver(s) who are not legal guardian(s) (Examples friends relatives parents offriends etc) o Other _________________________________________________________________
Name of person with whom student resides ___________________________~
Home Phone ___________ Cell Phone _________ Other Emergency _________
Length of Time at Previous
Name of the school where student is enrolled or in which student is attempting to enroll ____________
_ ~~__________ Last School Attended ______________Last District
Please check only one box that best describes where the student is presently living
o In my own home or apartment in Section 8 housing or in military housing with parent(s) legal guardian(s) or caregiver(s) (ifyou checked this box check one or both ofthe boxes below ifapplicable) (CODE=N)
o My home has no electricity (CODE=U)
o My home has no running water (CODE=U)
o In the home of a friend or relative because I lost my housing (examples fire flood lost job divorce domestic violence kicked out by parents parent in military and was deployed parent(s) injai etc (CODE=D)
o In a shelter becallse I do not have permanent hOllsing (examples living in a family shelter domestic violence shelter childrenyouth shelter FEMA housing) (CODE=S)
o In transitional housing (housing that is available for a specific length oftime only and is partly or completely paid for by a church a nonprofit organization or another organization) (CODE=S)
o In a hotel or motel (examples because ofeconomic hardship eviction cannot get deposits for permanent home floodfire hurricane efc) (CODE=HM)
o In a tent car van abandoned building on the streets at a campground in the park or other unsheltered location (CODE=U)
o None of the above describe my present living situation Briefly describe your situation _________~
Factors contributing to the students current living situation (check all that apply)
o Natural disaster
0 Tornado storm flood etc
o Hurricane name
o Fire prairie forest grass lightning strike etc
o Family issues such as divorce domestic violence kicked out by parents student left due to family conflict etc
o Home issues such as lack of electricity water heat adequate home repair due to lack of funds overcrowding mold etc
o Military Parentguardian deployed injured or killed in action
o Incarceration of parentguardian
o Incapacitation of parent or guardian due to health mental health drugsalcohol or other factors
o Home fire not due to natural causes (i e faulty equipmentappl iancesWiring furnace stove fireplace etc)
o Economic hardship
o Loss of job resulting in inability to pay rent or mortgage
o Income from part-time or low paying job does not cover cost of housing in the area
o Loss of mortgage including loss of mortgage of landlord if studentstudents family is renting
o Eviction record andor inability to produce deposits for rent or utilities
o High medical bills that leave little or no money for housing
o Lack of affordable housing in the area
o Minor student unable to afford housing on my own
o None of the above describe the main reasons for my present living situation Briefly explain the contributing factors _______________________________________
Please provide the following information for school-age siblings (brothers andor sisters) of the student
Name Grade Level School District
Signature of ParentLcgal GuardianCaregiverlUnaccompanied Student Date
For School Use Only I certify the above named student qualifies for the Child Nutrition Program under the provisions of the McKinney-Vento Act
McKinney-Vento Liaison Signature Date
New Student Information Conroe Independent School District
Creighton Elementary SchoolCampus _________________________________________________ Date ___________________
Students name _____~~__ ~____~__________ ~____~______ _______ __ ____ _0-______ Age ____
Date of birth ________ Grade _____ Student ID IImiddot ____ ____________
Has your child ever been enrolled in a Conroe Independent School District school before
1fyes name of school(s
Has your child ever repeated a
1fyes which grade(s)
Check Yes or No to indicate whe~er your child has ever received service~ in any of the following programs
Special Education including Speech
Special Reading or Math program (not in Special Education)
Migrant program
BilingualESL program
Gifted and Talented program
Section 504
Please note that official testing or other academic documentation may be required for your child to qualify in the Conroe Independent School District for any of the special programs marked Yes
FOR OFFICE ONLY
Entry
Teacher -__----------shy TRex
Cum Request _________
Info Updated _____ ___
lE1MS 706
Name of student (Nombre del estudiante) _______________________
Address (Domicilio)
ID (Numero de identificaci6n) _~____ Grade (Grado) ___
This fonn should be filled in and signed by parent or guardian for pre-kindergarten-8 students or by the student in grades 9-12 (Este formulari 0 debe completarlo y firmarlo el padremadre 0 tutor legal de los estudiantes que cursan los grados de prekindergarten a octavo 0 por el estudiante en los gmdos superiores)
Refer to Chapter 89 1215
What language is spoken in your home most of the time ~Cual es el idioma que mas se habla en su
What language does your child speak most of the time ~Cual es el idioma que mas habla su hijoa _________________
What language does your child speak and understand best zQue idioma habla y entiende mejor su hijoa _________________
Has your child lived outside the United States for two or more consecutive years zHa vivido su hijoa fuera de los Estados Unidos por dos 0 mas anos consecutivos C Yes No
How long has your child lived in the United States iCwinto tiempo ha vivido su hijoa en los Estados Unidos _________________
Has your sondaughter changed school districts within the last three years LSe ha cambiado su hljoa de distrito escolar durante los ultimos tres aiios 0 Yes 0 No
Did your child attend school regularly in the United States or in hisher native country LAsisti6 su hijoa con regularidad ala escuela en los Estados Unidos 0 palS nativo D Yes 0 No
Yes my child attended school regularly in the United States or in my country of origin and finished the previous grade Si mi hijoa asisti6 con regularidad ala escuela en los Estados Unidos 0 en mi pais de origen y termin6 el grado inmediato anterior
o No my child did not attend school regularly in the United States or in my country of origin and did not finish the previous grade as stated below (Specify the grade month and year your child failed to attend school Do not include if absences were less than a month) No mi hijoa no asisti6 con regularidad a la escuela en los Estados Unidos ni en mi pais de origen yno termin6 el grado inmediato anterior segun se especifica (Especifique el grado mes y ano cuando S1-l hijoa no asisti6 a la escuela No incluya este dato si falt6 a la escuela menos de un mes)
__-__---shy---------~----
Signature of parent (Firma del o tutor legal)
CISDmiddot17 (9111) White copymiddot Cumulative Folder Yellow copymiddot Green Foldermiddot Pink copy AI-risk Counselor lCavh~t~OI~lonQ IVI_~~pl)oamprcI~XJIIrvt~ltrtt1lII_apy~J 81IJ1ltn-Irf~ptC9 UocUgtJI II-laquoJ~IIIlaquon ~mgtIlOYInD-eoJtrylliloVlTnoWiJCflylt~(J~o cdod
ToIXctIhooE~~d 15n a~~Ogtt~_d 1915 fndS ~d II_411mdlfrau-_ta ~n~ _~ aorlJdlytlor--shy
i[Mtf~~_c(prPflais ~IWP~__~_fOlpVN~~~~ c~VI~_~lIk1OatJltf__dillcJ~_~ovou_tJo~ltJo _ fJ~$If~~ _ IN~ IIOQIIQul_ffir_Yl rl__ W~kbodl~ClWn I64 f __bull rlMoalthgtliltspound~1L-u_ ~T_ ooIl4da~f_ 19 ~ soamp5()iltM~~ 191) _~_tu~ltUOO ~u_CltI~p
Texas Education Agency Texas Public School StudenUStaff Ethnicity and Race Data Questionnaire
The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting thedata for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity Is the person HispanicLatino (Choose only one)
D HispanicLatino - A person of Cuban Mexican Puerto Rican South or Central American or other Spanish culture or origin regardless of race
D Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more)
D American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America) and who maintains a tribal affiliation or community attachment
D Asian - A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Philippine Islands Thailand and Vietnam
D Black or African American - A person having origins in any of the black racial groups of Africa
o Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii Guam Samoa or other Pacific Islands
o White - A person having origins in any of the original peoples of Europe the Middle East or North Africa
StudentlStaff Name (please print) (ParentlG uardian)(Staff) Signature
StudentlStaff Identification Number Date
-----
-------
----
I
I
Conroe Independent School District (170902) Creighton Elementary School 106
Campus Namenumber
Students Legal Name Student ID
Please fill out the following information for all school in which this student was previously enrolled
Narne of Schoo1 School District School Numbers Dates of enrollment Grades (city amp State)
---~~~
-~~~
~~~~~
middot ROE INDEPENDENT SCHOOL DISTRICT
(0 S Almiddotlt~L
This-free and reduced meal application is included in your Kindergarten packet to give you an opportunity to apply for free or reduced meals fell your student as heshe begins the 2014-15 school vea- at Conroe ISO By filling this out and submitting it our department can determine if yourrst~dent qualifies for the free or reduced lunch and if heshe qualifies can begin eating the
first day of schooL Please submit a new application next school year when you receive it because tltis application after approval is only good (or the first 30 days ofscltool Online applications are available and can be accessed through the Child Nutrition website We ENCOURAGE all families to apply on-line as this takes about twenty-Cour hours to process unless the student is not in the system yet The online application witl open the week of August 4h Parents can apply at wwwpplvforlunchcol11
Thank You Child Nutrition
Esta carta y la solicitud de comidas gratis 0 a precio reducido vienen dentro del paquete de inscripci6n al Jardin de Niflos (Kindergarten) para que usted pueda solicitar comidas gratis 0 a precio reducido para SlI estudiante durante el cicio escolar 2014-15 en Conroe ISD Una vez que usted entregue esta sol icitlld Ilena nuestro departamento podni determinar si SlI estudiante cllmple can los requisitos para recibir comidas gratis 0 a precio reducido En caso de que su
estudiante sea aprobado ellella podnl recibir com ida desde el primer dia de clases Nota Usted deberii lIenar V devolver una nueva solicitlld en cilanto la reciba al inicio del siguiente cicio escolar porque est primera solicitlld es temporal solamente sera valida dllrante los primeros 30 dias de clase (en ClISO de aber sido aprobada) Tambien podra lIenar la solicitud en linea Busquela en nllestra pagina electr6nica en el menLI PARENTS y luego en CHILD NUTRITION Invitamos a las familias a que tramitel1 su solicitud en lfnea debido a que este tnil11ite solamente dura 24 horas a menos que el estudiante no este dado de alta en el sistema La opci6n de presentar Ia solicitud en linea se abrira durante la semana del4 de agosto Los padres podran tramitar su solicitud en wwwapplyforlul1chcom
Atentamente Departamento de Nutrici6n Infantil
2015 -2016 1--middotmiddotFamilv Survev I Campus name Campus Conroe ISO -170902 L-I---------------- shy
N arne of child ---------------____-------shy
Grade level ---__ - Date
Dear Parents
In order to better serve your children the school district would like to identify students who may qualify to receive additional educational services The information provided below will be kept confidential Please answer the following questions and return this survey to your childs school
Please provide the following information (Only if yes was answered to questions 1 amp 2 above)
Name of child ____ _ ___ Age ___ Grade ___
Father Guardian ~__ __~__~__________________~_ _____________~
Mother Guardian _ _________
Street City State Zip
Home Telephone Number __ _____~
Other Phone _____ bull--- ------ ------- shy
The Conroe Independent Schoo District does not discriminate on the basis ot race color naUana origin sex disability or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups The followlng persons have been designated to handle inquiries regatdlng these non-discrimination pofiCies
l1na IX Coordinator 3205 W Davis COnroe Texas 77304 (936l-709~7700 and the Section 504ADA Coordinator 3205 W Oavis Conroe Texas 77304 (936) 709middot7670
Community Outreach and Dropout Prevention Rodrigo Chaves DirectorNROE
INDEPENDENT SCHOOL DISTRICT 3205 West Davis bull Conroe Texas 77304-2098 ~to-amp~ 9367097759
bull bull
Conroe Independent School District 2015-2016 Application for Free and Reduced Price School Meals Return to the school cafeteria manager or mail to the Conroe ISO Child Nutrition Department
bull Use black ink Print neatly Complete one application per household 3205 West Davis Conroe TX 77302-2098
~ List ALL household members who are infants children and students up to and including grade 12 (If more space is required for additional names attach another sheet ofpaper) Homeloss
Brthdate School roster migrant Legal first name MI Legal last name MM DO yy Grade Code Child runaway
Definition of Household Member Anyone who is living with you and shares income and expenses even if not related
Children in foster care and children who meet the definition of Homeless Migrant or Runaway are eligible for free meals Read How to Apply for Free and Reduced Price School Meals for more information
~ Do any Household Members (including you) currently participate in one or more of the following assistance programs SNAP TANF FDPIR Check the appropriate box below
If you did not check one of the boxes If you Checked one of the boxes to the left write EDG number here
SNAP TANF FDPIR to the leI conplete SECTION 3 then go to SECTiON 4 (Do Not complete SECTION 3) EDG number ~ Report income for ALL Household Members (skip this step if you answered yes to SECTION 2)
A Child Income Sometimes children in the household earn income Please indicate the TOTAL income earned by all Household Members in SECTION 1 here Child income
B All Adult Household Members (including yourself) List all Household Members not listed in SECTION 1 (including yourself) even if they did not receive income For each Household Member listed if they receive income report total income for each source in whole dollars ONLY If they Do Not receive income from any WET M source check the no income box If you check the no income box yu are certifying (promising) that there is no income to report
W = Weekly E Every two weeks T Twice per month M Monthly A = Annually Public Assistance
Name of Adult Household Member (first and last) Earnings from work Fill In circle Child SupporVAlimony Fill in circleI I Please read How to 81 Apply for Free and Reduced Price School Meals for more information The Sources of Income for Children section will help
lEC ryou wijh the Child Income questions The Sources of Income for Adults section will help you with EMJ the All Adult Household Members section
bull Write total number of Household Members here Last four digits of Social Security Number (SSN)
~ Contact Information and Adult Signature I certify (promise) that all infmation on this application is true and that all income is reported I understand that this information is given in connection with the receipt of Federal funds and that school officials may verify (check) the information I am aware that if I purposely give false information my children may lose meal benefits and I may be prosecuted under applicable State and Federal laws Street address Zip Daytime phone
~-~T-T---~r---~r------------------~ ~~--- i
bull Do not fill out this part For school use only Printed name of adult completing this form xsign here Todays date
Received Reviewing officials signature Date Confirming officials Signature _ Date FollOW-Up officials signature Date
~ --~~~~~~~------
Printed name ofstuqent
Signature ofstudent
Signature ofparent
~~ --~
Date
INDEPENDENT SCHOOL DISTRICT
~to-amp~
Nombre del alumno (tetra de molde)
FIrma del alumno
Finna del padre
Fecha
I unders+anc I wilt haJ~ to pick +hi~ Ll~ -frOYl the- -9r0nt office yo emendD qyc de-bo
de leC0cter eS+Gl COplCV d~ let ofc-incc prinCipal
Dear Pltlrent or Guardian
Throughout the year different orgmizations come to Creighton Elementary wanting to assist our shldents and families with school supplies clothing and other various needs The Family Educational Rights and privacy Act a federal law that make student educational records confidentiat prohibits us from releltlsing student information to these ltlgencies without your permission Tb help us work with these groups in the most efficient way possible we ask that if you are interested in such assistance you complete and sign the form below The form should be rehlmed to Susan Fossler
These assistance programs vary from year to year Giving us permission to release your information does not automatically mean vou will receive assistance It does let ~tS knmj that you would welcome such assistance and would be willing to have your information released to these orgaJ~izations In turn these groups agree to use your information only for the purpose of their assistance program(s) It is also required that your consent for release of information be updated annually If you have a question feel free to contact your childs counselor
Sincerely
Jenny Watson Principal
Shldent name Nomlm dd (studiallte _
Parents names Nombre dc padre 0 cllcl1Ixado __
AddressDirccci611
Phone Tcitfi)ffo
Are there siblings ~Ticllc hermallitos i_- yes sl no noJ
Estimado Padre de Familia 0 encargado
Durante el ano diferentes organizaciones vienen a la escuela Creighton Elementary con eJ objetivo de
ayudar a nuestros estudiantes y sus familia res con utiles escolares ropa y otras necesidades
El Acto de Privacidad y Derechos Educacionales de la Familia una ley federal que hace que los archivos e historial educativo del eshldiante sean confidenciales nos prohibe que divulguemos informacion de estudiantes a tales organizaciones sin e1
permiso suyo Para que nos ayude a trabajar y cooperltlr con esas organizaciones de la manera
mas eficiente Ie pedimos que si LIsted esta interesado (a) en recibir dicho tipo de asistencia 0
ayuda que complete y firme la forma abajo Esta forma la debe de regresar a Susan Fossler
Estos programas de asistencia varian de ano a ano El que nos autorice a dar el permiso pedido no signifiea que recibira ayuda automaticamente Lo que nos indica es que LJsted esta dispuesto (a) a recibir dicha asistencia y que acepta que la informacion suya sea compartida con esas organizaciones Esto pennite a que estos grupos y organizaciones acuerden usar dicha informacion soJamente para e1 prop6sito del program de asistencia Tambien se requiere que renueve este permiso de divulgaci6n de informacion anualmente Si tiene alguna pregunta contacte al consejero (a) de su hijo (a)
Sincerely
Jenny Watson Prillcipal
If yes names and ages of siblings I Nomnc y cdad de los hCrl11111 itos
Parent signature Firma del padre Date I Fecha
---------
Parents Please complete back of form (page 2) Teacher check one r No-show lirst ~
ICONROEINDEPENDENT Registration Form - New Students ISCHOOL DISTRICT
~~---
106Campus No 1 70902
Creighton Elementary SchoolCampus
last
Sex ______ Birth Date ~__~__~_~___ __Student ID
Student resides with Omother Ofather
Phone (home) ~___~__~__ (workL--- ___~____
Guardian Email addresses ---~----~-----------------------------------~-----------------~-
Students Physical Address _________ ------- --- shy-----------~ street address city zip
Street address city zip
Other parentguardian information if applicable
Name _________~_____________ ______________ Phone (home) ____~~__~ _ (worki_ _ ____~___
Physical Address ________~__ ----------~ street address city zip
Other ParentGuardian Email addresses __~_______________________
Warning It is a criminal offense pursuant to Texas Penal Code 3710 for a person to knowingly falsify information on a form required for a students enrollment in the District This is such a form
Parentguardian signature required for enrollment ofstudent Si es necesario por favor pedir la forma en espano
I am aware that in order for my child to attend school in the Conroe lSD my child must meet the districts residency requirements or be granted an approved Interdistrict transfer I acknowledge that 1have read and understand the penalties of falsified information as stated in the Texas Education Code sect25001 (h) printed below I also agree to inform the proper school authorities immediately should I move from the address indicated Proof of residency is required
Texas Education Code sect25001 h In addition to the penalty provided by sect3 71 0 of the Penal Code a person who knowingly falsifies information on a form required for
enrollment of a student in a school district is liable to the district if the student is not eligible for enrollment in the district but is enrolled on the basis of the false information The person is liable for the period during which the ineligible student is enrolled for the greater of
1) the maximum tuition fee the district may charge under sect25038 of this code or 2) the amount the district has budgeted for each student as maintenance and operating expenses
I hereby certify one of the following a)primary guardian is a resident (managing conservator or legal guardians) blother legal parent is a resident (possessory conservator) clstudent signing form is at least 18 years of age and a resident of the district or d)student has been granted an approved Interdstrct transfer I understand that one of these conditions must be maintained in order for the student to attend the Conroe ISO I also agree to inform the proper school authorities immediately should Imove from the address indicated above
With my signature I acknowledge that I have read and verify the information on this registration form and that I understand the penalties of providing falsified information as stated above
ParentGuardian Signature Date
In order to meet Texas Education Agencys recommended guidelines (ISO is using social security numbers for the required PEIMS Reporting Number If you choose not to provide this information please provide the Districts Legal Department with written objection within ten days of the issuance of this notice
The Conroe Independent School District does not discriminate on the basis of race color national origin sex religion age or disability in its admissiOns policies or by excluding from participation in denying access to or denying the benefits of district services academic andor vocational and technology programs or activities as required by Title VI and Title VII of the CiVil Rights Act of 1964 as amended Title IX of the Education Amendments of 1972 the First Amendment of the United States Constitution the Age Discrimination Act of 1975 Section 504 of the Rehabilitation Act of 1973 as amended and Title of the Americans with Disabilities Act
For information about Title IX rights contact the Title IX Coordinator 3205 W Davis Conroe Texas 77304 (936)709-7700 For information about Section S04ADA rights contact the Section 504ADA Coordinator 3205 W Davis Conroe Texas 77304 (936)709middot7670
Parents should forward any medical information allergies or medical problems to the attention of the campus ~J
Administrative Enrollment
Administrator or DiagnosticianSpeech Therapists signatureltitle Date PEIMS (410) front (page 1)
-----
---- ---- ------
Bus No
School Bus Registration Form
Please complete the following information to ensure access to transportation services Vithollt prior registration your student lIIay not be able to ride the school bus until proper registration has bccn received by the Transportation Department
(Please print)
Date Campus Creighton Elementary School
Students name Student ID
Will student be riding the bus this year (Place an X in the appropriate box)
Always Sometimes No
shy
Complete the student information below ONLY if your student will need to ride the school bus
Birthdate Age Sex Grade -~---~
Home address
Phone (HomeCell) _--_-------shy
ParentGuardian name
ParentGuardian work phone
Emergency Contact (when parent or guardian can not be rcached)
)Jame Relationship to student
Address ----- --------------------- ---_----- _----shy
Phone )Jumbers ----------------------_--------- _-shy
ParentGuardian Signature
Conloe Independent School District Student Residency Questionnaire
The information on this form is required to meet the law known as the McKinney-Vento Act 42 USc 11434a(2) which is also known as Title X Part C of the No Child Left Behind Act The answers you give will help the school determine the services the student may be eligible to receive
Presenting a false record or falsifying records is an offense IInder Section 37 JO Penal code and enrollment of the child under false documents subjects the person 10 liability for tuition or other costs TEe Sec 25 002 (3)(d)
Name of Student ___________----_______________ Gender 0 Male 0 Female
Last First Middle
Birth Date __-----_--_ CampusCreighton Elementary Grade ____ Student Month Day Year
Check the box that best describes with whom the student resides (Please note legal guardianship may be granted only by a court students living on their own or with friends or relatives who do not have legal guardianship are allowed to enroll in and attend schoo The school cannot require proofofguardianship for enrollment or continued attendance)
o Parent(s)
o Legal Guardians(s)
o Caregiver(s) who are not legal guardian(s) (Examples friends relatives parents offriends etc) o Other _________________________________________________________________
Name of person with whom student resides ___________________________~
Home Phone ___________ Cell Phone _________ Other Emergency _________
Length of Time at Previous
Name of the school where student is enrolled or in which student is attempting to enroll ____________
_ ~~__________ Last School Attended ______________Last District
Please check only one box that best describes where the student is presently living
o In my own home or apartment in Section 8 housing or in military housing with parent(s) legal guardian(s) or caregiver(s) (ifyou checked this box check one or both ofthe boxes below ifapplicable) (CODE=N)
o My home has no electricity (CODE=U)
o My home has no running water (CODE=U)
o In the home of a friend or relative because I lost my housing (examples fire flood lost job divorce domestic violence kicked out by parents parent in military and was deployed parent(s) injai etc (CODE=D)
o In a shelter becallse I do not have permanent hOllsing (examples living in a family shelter domestic violence shelter childrenyouth shelter FEMA housing) (CODE=S)
o In transitional housing (housing that is available for a specific length oftime only and is partly or completely paid for by a church a nonprofit organization or another organization) (CODE=S)
o In a hotel or motel (examples because ofeconomic hardship eviction cannot get deposits for permanent home floodfire hurricane efc) (CODE=HM)
o In a tent car van abandoned building on the streets at a campground in the park or other unsheltered location (CODE=U)
o None of the above describe my present living situation Briefly describe your situation _________~
Factors contributing to the students current living situation (check all that apply)
o Natural disaster
0 Tornado storm flood etc
o Hurricane name
o Fire prairie forest grass lightning strike etc
o Family issues such as divorce domestic violence kicked out by parents student left due to family conflict etc
o Home issues such as lack of electricity water heat adequate home repair due to lack of funds overcrowding mold etc
o Military Parentguardian deployed injured or killed in action
o Incarceration of parentguardian
o Incapacitation of parent or guardian due to health mental health drugsalcohol or other factors
o Home fire not due to natural causes (i e faulty equipmentappl iancesWiring furnace stove fireplace etc)
o Economic hardship
o Loss of job resulting in inability to pay rent or mortgage
o Income from part-time or low paying job does not cover cost of housing in the area
o Loss of mortgage including loss of mortgage of landlord if studentstudents family is renting
o Eviction record andor inability to produce deposits for rent or utilities
o High medical bills that leave little or no money for housing
o Lack of affordable housing in the area
o Minor student unable to afford housing on my own
o None of the above describe the main reasons for my present living situation Briefly explain the contributing factors _______________________________________
Please provide the following information for school-age siblings (brothers andor sisters) of the student
Name Grade Level School District
Signature of ParentLcgal GuardianCaregiverlUnaccompanied Student Date
For School Use Only I certify the above named student qualifies for the Child Nutrition Program under the provisions of the McKinney-Vento Act
McKinney-Vento Liaison Signature Date
New Student Information Conroe Independent School District
Creighton Elementary SchoolCampus _________________________________________________ Date ___________________
Students name _____~~__ ~____~__________ ~____~______ _______ __ ____ _0-______ Age ____
Date of birth ________ Grade _____ Student ID IImiddot ____ ____________
Has your child ever been enrolled in a Conroe Independent School District school before
1fyes name of school(s
Has your child ever repeated a
1fyes which grade(s)
Check Yes or No to indicate whe~er your child has ever received service~ in any of the following programs
Special Education including Speech
Special Reading or Math program (not in Special Education)
Migrant program
BilingualESL program
Gifted and Talented program
Section 504
Please note that official testing or other academic documentation may be required for your child to qualify in the Conroe Independent School District for any of the special programs marked Yes
FOR OFFICE ONLY
Entry
Teacher -__----------shy TRex
Cum Request _________
Info Updated _____ ___
lE1MS 706
Name of student (Nombre del estudiante) _______________________
Address (Domicilio)
ID (Numero de identificaci6n) _~____ Grade (Grado) ___
This fonn should be filled in and signed by parent or guardian for pre-kindergarten-8 students or by the student in grades 9-12 (Este formulari 0 debe completarlo y firmarlo el padremadre 0 tutor legal de los estudiantes que cursan los grados de prekindergarten a octavo 0 por el estudiante en los gmdos superiores)
Refer to Chapter 89 1215
What language is spoken in your home most of the time ~Cual es el idioma que mas se habla en su
What language does your child speak most of the time ~Cual es el idioma que mas habla su hijoa _________________
What language does your child speak and understand best zQue idioma habla y entiende mejor su hijoa _________________
Has your child lived outside the United States for two or more consecutive years zHa vivido su hijoa fuera de los Estados Unidos por dos 0 mas anos consecutivos C Yes No
How long has your child lived in the United States iCwinto tiempo ha vivido su hijoa en los Estados Unidos _________________
Has your sondaughter changed school districts within the last three years LSe ha cambiado su hljoa de distrito escolar durante los ultimos tres aiios 0 Yes 0 No
Did your child attend school regularly in the United States or in hisher native country LAsisti6 su hijoa con regularidad ala escuela en los Estados Unidos 0 palS nativo D Yes 0 No
Yes my child attended school regularly in the United States or in my country of origin and finished the previous grade Si mi hijoa asisti6 con regularidad ala escuela en los Estados Unidos 0 en mi pais de origen y termin6 el grado inmediato anterior
o No my child did not attend school regularly in the United States or in my country of origin and did not finish the previous grade as stated below (Specify the grade month and year your child failed to attend school Do not include if absences were less than a month) No mi hijoa no asisti6 con regularidad a la escuela en los Estados Unidos ni en mi pais de origen yno termin6 el grado inmediato anterior segun se especifica (Especifique el grado mes y ano cuando S1-l hijoa no asisti6 a la escuela No incluya este dato si falt6 a la escuela menos de un mes)
__-__---shy---------~----
Signature of parent (Firma del o tutor legal)
CISDmiddot17 (9111) White copymiddot Cumulative Folder Yellow copymiddot Green Foldermiddot Pink copy AI-risk Counselor lCavh~t~OI~lonQ IVI_~~pl)oamprcI~XJIIrvt~ltrtt1lII_apy~J 81IJ1ltn-Irf~ptC9 UocUgtJI II-laquoJ~IIIlaquon ~mgtIlOYInD-eoJtrylliloVlTnoWiJCflylt~(J~o cdod
ToIXctIhooE~~d 15n a~~Ogtt~_d 1915 fndS ~d II_411mdlfrau-_ta ~n~ _~ aorlJdlytlor--shy
i[Mtf~~_c(prPflais ~IWP~__~_fOlpVN~~~~ c~VI~_~lIk1OatJltf__dillcJ~_~ovou_tJo~ltJo _ fJ~$If~~ _ IN~ IIOQIIQul_ffir_Yl rl__ W~kbodl~ClWn I64 f __bull rlMoalthgtliltspound~1L-u_ ~T_ ooIl4da~f_ 19 ~ soamp5()iltM~~ 191) _~_tu~ltUOO ~u_CltI~p
Texas Education Agency Texas Public School StudenUStaff Ethnicity and Race Data Questionnaire
The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting thedata for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity Is the person HispanicLatino (Choose only one)
D HispanicLatino - A person of Cuban Mexican Puerto Rican South or Central American or other Spanish culture or origin regardless of race
D Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more)
D American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America) and who maintains a tribal affiliation or community attachment
D Asian - A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Philippine Islands Thailand and Vietnam
D Black or African American - A person having origins in any of the black racial groups of Africa
o Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii Guam Samoa or other Pacific Islands
o White - A person having origins in any of the original peoples of Europe the Middle East or North Africa
StudentlStaff Name (please print) (ParentlG uardian)(Staff) Signature
StudentlStaff Identification Number Date
-----
-------
----
I
I
Conroe Independent School District (170902) Creighton Elementary School 106
Campus Namenumber
Students Legal Name Student ID
Please fill out the following information for all school in which this student was previously enrolled
Narne of Schoo1 School District School Numbers Dates of enrollment Grades (city amp State)
---~~~
-~~~
~~~~~
middot ROE INDEPENDENT SCHOOL DISTRICT
(0 S Almiddotlt~L
This-free and reduced meal application is included in your Kindergarten packet to give you an opportunity to apply for free or reduced meals fell your student as heshe begins the 2014-15 school vea- at Conroe ISO By filling this out and submitting it our department can determine if yourrst~dent qualifies for the free or reduced lunch and if heshe qualifies can begin eating the
first day of schooL Please submit a new application next school year when you receive it because tltis application after approval is only good (or the first 30 days ofscltool Online applications are available and can be accessed through the Child Nutrition website We ENCOURAGE all families to apply on-line as this takes about twenty-Cour hours to process unless the student is not in the system yet The online application witl open the week of August 4h Parents can apply at wwwpplvforlunchcol11
Thank You Child Nutrition
Esta carta y la solicitud de comidas gratis 0 a precio reducido vienen dentro del paquete de inscripci6n al Jardin de Niflos (Kindergarten) para que usted pueda solicitar comidas gratis 0 a precio reducido para SlI estudiante durante el cicio escolar 2014-15 en Conroe ISD Una vez que usted entregue esta sol icitlld Ilena nuestro departamento podni determinar si SlI estudiante cllmple can los requisitos para recibir comidas gratis 0 a precio reducido En caso de que su
estudiante sea aprobado ellella podnl recibir com ida desde el primer dia de clases Nota Usted deberii lIenar V devolver una nueva solicitlld en cilanto la reciba al inicio del siguiente cicio escolar porque est primera solicitlld es temporal solamente sera valida dllrante los primeros 30 dias de clase (en ClISO de aber sido aprobada) Tambien podra lIenar la solicitud en linea Busquela en nllestra pagina electr6nica en el menLI PARENTS y luego en CHILD NUTRITION Invitamos a las familias a que tramitel1 su solicitud en lfnea debido a que este tnil11ite solamente dura 24 horas a menos que el estudiante no este dado de alta en el sistema La opci6n de presentar Ia solicitud en linea se abrira durante la semana del4 de agosto Los padres podran tramitar su solicitud en wwwapplyforlul1chcom
Atentamente Departamento de Nutrici6n Infantil
2015 -2016 1--middotmiddotFamilv Survev I Campus name Campus Conroe ISO -170902 L-I---------------- shy
N arne of child ---------------____-------shy
Grade level ---__ - Date
Dear Parents
In order to better serve your children the school district would like to identify students who may qualify to receive additional educational services The information provided below will be kept confidential Please answer the following questions and return this survey to your childs school
Please provide the following information (Only if yes was answered to questions 1 amp 2 above)
Name of child ____ _ ___ Age ___ Grade ___
Father Guardian ~__ __~__~__________________~_ _____________~
Mother Guardian _ _________
Street City State Zip
Home Telephone Number __ _____~
Other Phone _____ bull--- ------ ------- shy
The Conroe Independent Schoo District does not discriminate on the basis ot race color naUana origin sex disability or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups The followlng persons have been designated to handle inquiries regatdlng these non-discrimination pofiCies
l1na IX Coordinator 3205 W Davis COnroe Texas 77304 (936l-709~7700 and the Section 504ADA Coordinator 3205 W Oavis Conroe Texas 77304 (936) 709middot7670
Community Outreach and Dropout Prevention Rodrigo Chaves DirectorNROE
INDEPENDENT SCHOOL DISTRICT 3205 West Davis bull Conroe Texas 77304-2098 ~to-amp~ 9367097759
bull bull
Conroe Independent School District 2015-2016 Application for Free and Reduced Price School Meals Return to the school cafeteria manager or mail to the Conroe ISO Child Nutrition Department
bull Use black ink Print neatly Complete one application per household 3205 West Davis Conroe TX 77302-2098
~ List ALL household members who are infants children and students up to and including grade 12 (If more space is required for additional names attach another sheet ofpaper) Homeloss
Brthdate School roster migrant Legal first name MI Legal last name MM DO yy Grade Code Child runaway
Definition of Household Member Anyone who is living with you and shares income and expenses even if not related
Children in foster care and children who meet the definition of Homeless Migrant or Runaway are eligible for free meals Read How to Apply for Free and Reduced Price School Meals for more information
~ Do any Household Members (including you) currently participate in one or more of the following assistance programs SNAP TANF FDPIR Check the appropriate box below
If you did not check one of the boxes If you Checked one of the boxes to the left write EDG number here
SNAP TANF FDPIR to the leI conplete SECTION 3 then go to SECTiON 4 (Do Not complete SECTION 3) EDG number ~ Report income for ALL Household Members (skip this step if you answered yes to SECTION 2)
A Child Income Sometimes children in the household earn income Please indicate the TOTAL income earned by all Household Members in SECTION 1 here Child income
B All Adult Household Members (including yourself) List all Household Members not listed in SECTION 1 (including yourself) even if they did not receive income For each Household Member listed if they receive income report total income for each source in whole dollars ONLY If they Do Not receive income from any WET M source check the no income box If you check the no income box yu are certifying (promising) that there is no income to report
W = Weekly E Every two weeks T Twice per month M Monthly A = Annually Public Assistance
Name of Adult Household Member (first and last) Earnings from work Fill In circle Child SupporVAlimony Fill in circleI I Please read How to 81 Apply for Free and Reduced Price School Meals for more information The Sources of Income for Children section will help
lEC ryou wijh the Child Income questions The Sources of Income for Adults section will help you with EMJ the All Adult Household Members section
bull Write total number of Household Members here Last four digits of Social Security Number (SSN)
~ Contact Information and Adult Signature I certify (promise) that all infmation on this application is true and that all income is reported I understand that this information is given in connection with the receipt of Federal funds and that school officials may verify (check) the information I am aware that if I purposely give false information my children may lose meal benefits and I may be prosecuted under applicable State and Federal laws Street address Zip Daytime phone
~-~T-T---~r---~r------------------~ ~~--- i
bull Do not fill out this part For school use only Printed name of adult completing this form xsign here Todays date
Received Reviewing officials signature Date Confirming officials Signature _ Date FollOW-Up officials signature Date
~ --~~~~~~~------
Printed name ofstuqent
Signature ofstudent
Signature ofparent
~~ --~
Date
INDEPENDENT SCHOOL DISTRICT
~to-amp~
Nombre del alumno (tetra de molde)
FIrma del alumno
Finna del padre
Fecha
I unders+anc I wilt haJ~ to pick +hi~ Ll~ -frOYl the- -9r0nt office yo emendD qyc de-bo
de leC0cter eS+Gl COplCV d~ let ofc-incc prinCipal
Dear Pltlrent or Guardian
Throughout the year different orgmizations come to Creighton Elementary wanting to assist our shldents and families with school supplies clothing and other various needs The Family Educational Rights and privacy Act a federal law that make student educational records confidentiat prohibits us from releltlsing student information to these ltlgencies without your permission Tb help us work with these groups in the most efficient way possible we ask that if you are interested in such assistance you complete and sign the form below The form should be rehlmed to Susan Fossler
These assistance programs vary from year to year Giving us permission to release your information does not automatically mean vou will receive assistance It does let ~tS knmj that you would welcome such assistance and would be willing to have your information released to these orgaJ~izations In turn these groups agree to use your information only for the purpose of their assistance program(s) It is also required that your consent for release of information be updated annually If you have a question feel free to contact your childs counselor
Sincerely
Jenny Watson Principal
Shldent name Nomlm dd (studiallte _
Parents names Nombre dc padre 0 cllcl1Ixado __
AddressDirccci611
Phone Tcitfi)ffo
Are there siblings ~Ticllc hermallitos i_- yes sl no noJ
Estimado Padre de Familia 0 encargado
Durante el ano diferentes organizaciones vienen a la escuela Creighton Elementary con eJ objetivo de
ayudar a nuestros estudiantes y sus familia res con utiles escolares ropa y otras necesidades
El Acto de Privacidad y Derechos Educacionales de la Familia una ley federal que hace que los archivos e historial educativo del eshldiante sean confidenciales nos prohibe que divulguemos informacion de estudiantes a tales organizaciones sin e1
permiso suyo Para que nos ayude a trabajar y cooperltlr con esas organizaciones de la manera
mas eficiente Ie pedimos que si LIsted esta interesado (a) en recibir dicho tipo de asistencia 0
ayuda que complete y firme la forma abajo Esta forma la debe de regresar a Susan Fossler
Estos programas de asistencia varian de ano a ano El que nos autorice a dar el permiso pedido no signifiea que recibira ayuda automaticamente Lo que nos indica es que LJsted esta dispuesto (a) a recibir dicha asistencia y que acepta que la informacion suya sea compartida con esas organizaciones Esto pennite a que estos grupos y organizaciones acuerden usar dicha informacion soJamente para e1 prop6sito del program de asistencia Tambien se requiere que renueve este permiso de divulgaci6n de informacion anualmente Si tiene alguna pregunta contacte al consejero (a) de su hijo (a)
Sincerely
Jenny Watson Prillcipal
If yes names and ages of siblings I Nomnc y cdad de los hCrl11111 itos
Parent signature Firma del padre Date I Fecha
-----
---- ---- ------
Bus No
School Bus Registration Form
Please complete the following information to ensure access to transportation services Vithollt prior registration your student lIIay not be able to ride the school bus until proper registration has bccn received by the Transportation Department
(Please print)
Date Campus Creighton Elementary School
Students name Student ID
Will student be riding the bus this year (Place an X in the appropriate box)
Always Sometimes No
shy
Complete the student information below ONLY if your student will need to ride the school bus
Birthdate Age Sex Grade -~---~
Home address
Phone (HomeCell) _--_-------shy
ParentGuardian name
ParentGuardian work phone
Emergency Contact (when parent or guardian can not be rcached)
)Jame Relationship to student
Address ----- --------------------- ---_----- _----shy
Phone )Jumbers ----------------------_--------- _-shy
ParentGuardian Signature
Conloe Independent School District Student Residency Questionnaire
The information on this form is required to meet the law known as the McKinney-Vento Act 42 USc 11434a(2) which is also known as Title X Part C of the No Child Left Behind Act The answers you give will help the school determine the services the student may be eligible to receive
Presenting a false record or falsifying records is an offense IInder Section 37 JO Penal code and enrollment of the child under false documents subjects the person 10 liability for tuition or other costs TEe Sec 25 002 (3)(d)
Name of Student ___________----_______________ Gender 0 Male 0 Female
Last First Middle
Birth Date __-----_--_ CampusCreighton Elementary Grade ____ Student Month Day Year
Check the box that best describes with whom the student resides (Please note legal guardianship may be granted only by a court students living on their own or with friends or relatives who do not have legal guardianship are allowed to enroll in and attend schoo The school cannot require proofofguardianship for enrollment or continued attendance)
o Parent(s)
o Legal Guardians(s)
o Caregiver(s) who are not legal guardian(s) (Examples friends relatives parents offriends etc) o Other _________________________________________________________________
Name of person with whom student resides ___________________________~
Home Phone ___________ Cell Phone _________ Other Emergency _________
Length of Time at Previous
Name of the school where student is enrolled or in which student is attempting to enroll ____________
_ ~~__________ Last School Attended ______________Last District
Please check only one box that best describes where the student is presently living
o In my own home or apartment in Section 8 housing or in military housing with parent(s) legal guardian(s) or caregiver(s) (ifyou checked this box check one or both ofthe boxes below ifapplicable) (CODE=N)
o My home has no electricity (CODE=U)
o My home has no running water (CODE=U)
o In the home of a friend or relative because I lost my housing (examples fire flood lost job divorce domestic violence kicked out by parents parent in military and was deployed parent(s) injai etc (CODE=D)
o In a shelter becallse I do not have permanent hOllsing (examples living in a family shelter domestic violence shelter childrenyouth shelter FEMA housing) (CODE=S)
o In transitional housing (housing that is available for a specific length oftime only and is partly or completely paid for by a church a nonprofit organization or another organization) (CODE=S)
o In a hotel or motel (examples because ofeconomic hardship eviction cannot get deposits for permanent home floodfire hurricane efc) (CODE=HM)
o In a tent car van abandoned building on the streets at a campground in the park or other unsheltered location (CODE=U)
o None of the above describe my present living situation Briefly describe your situation _________~
Factors contributing to the students current living situation (check all that apply)
o Natural disaster
0 Tornado storm flood etc
o Hurricane name
o Fire prairie forest grass lightning strike etc
o Family issues such as divorce domestic violence kicked out by parents student left due to family conflict etc
o Home issues such as lack of electricity water heat adequate home repair due to lack of funds overcrowding mold etc
o Military Parentguardian deployed injured or killed in action
o Incarceration of parentguardian
o Incapacitation of parent or guardian due to health mental health drugsalcohol or other factors
o Home fire not due to natural causes (i e faulty equipmentappl iancesWiring furnace stove fireplace etc)
o Economic hardship
o Loss of job resulting in inability to pay rent or mortgage
o Income from part-time or low paying job does not cover cost of housing in the area
o Loss of mortgage including loss of mortgage of landlord if studentstudents family is renting
o Eviction record andor inability to produce deposits for rent or utilities
o High medical bills that leave little or no money for housing
o Lack of affordable housing in the area
o Minor student unable to afford housing on my own
o None of the above describe the main reasons for my present living situation Briefly explain the contributing factors _______________________________________
Please provide the following information for school-age siblings (brothers andor sisters) of the student
Name Grade Level School District
Signature of ParentLcgal GuardianCaregiverlUnaccompanied Student Date
For School Use Only I certify the above named student qualifies for the Child Nutrition Program under the provisions of the McKinney-Vento Act
McKinney-Vento Liaison Signature Date
New Student Information Conroe Independent School District
Creighton Elementary SchoolCampus _________________________________________________ Date ___________________
Students name _____~~__ ~____~__________ ~____~______ _______ __ ____ _0-______ Age ____
Date of birth ________ Grade _____ Student ID IImiddot ____ ____________
Has your child ever been enrolled in a Conroe Independent School District school before
1fyes name of school(s
Has your child ever repeated a
1fyes which grade(s)
Check Yes or No to indicate whe~er your child has ever received service~ in any of the following programs
Special Education including Speech
Special Reading or Math program (not in Special Education)
Migrant program
BilingualESL program
Gifted and Talented program
Section 504
Please note that official testing or other academic documentation may be required for your child to qualify in the Conroe Independent School District for any of the special programs marked Yes
FOR OFFICE ONLY
Entry
Teacher -__----------shy TRex
Cum Request _________
Info Updated _____ ___
lE1MS 706
Name of student (Nombre del estudiante) _______________________
Address (Domicilio)
ID (Numero de identificaci6n) _~____ Grade (Grado) ___
This fonn should be filled in and signed by parent or guardian for pre-kindergarten-8 students or by the student in grades 9-12 (Este formulari 0 debe completarlo y firmarlo el padremadre 0 tutor legal de los estudiantes que cursan los grados de prekindergarten a octavo 0 por el estudiante en los gmdos superiores)
Refer to Chapter 89 1215
What language is spoken in your home most of the time ~Cual es el idioma que mas se habla en su
What language does your child speak most of the time ~Cual es el idioma que mas habla su hijoa _________________
What language does your child speak and understand best zQue idioma habla y entiende mejor su hijoa _________________
Has your child lived outside the United States for two or more consecutive years zHa vivido su hijoa fuera de los Estados Unidos por dos 0 mas anos consecutivos C Yes No
How long has your child lived in the United States iCwinto tiempo ha vivido su hijoa en los Estados Unidos _________________
Has your sondaughter changed school districts within the last three years LSe ha cambiado su hljoa de distrito escolar durante los ultimos tres aiios 0 Yes 0 No
Did your child attend school regularly in the United States or in hisher native country LAsisti6 su hijoa con regularidad ala escuela en los Estados Unidos 0 palS nativo D Yes 0 No
Yes my child attended school regularly in the United States or in my country of origin and finished the previous grade Si mi hijoa asisti6 con regularidad ala escuela en los Estados Unidos 0 en mi pais de origen y termin6 el grado inmediato anterior
o No my child did not attend school regularly in the United States or in my country of origin and did not finish the previous grade as stated below (Specify the grade month and year your child failed to attend school Do not include if absences were less than a month) No mi hijoa no asisti6 con regularidad a la escuela en los Estados Unidos ni en mi pais de origen yno termin6 el grado inmediato anterior segun se especifica (Especifique el grado mes y ano cuando S1-l hijoa no asisti6 a la escuela No incluya este dato si falt6 a la escuela menos de un mes)
__-__---shy---------~----
Signature of parent (Firma del o tutor legal)
CISDmiddot17 (9111) White copymiddot Cumulative Folder Yellow copymiddot Green Foldermiddot Pink copy AI-risk Counselor lCavh~t~OI~lonQ IVI_~~pl)oamprcI~XJIIrvt~ltrtt1lII_apy~J 81IJ1ltn-Irf~ptC9 UocUgtJI II-laquoJ~IIIlaquon ~mgtIlOYInD-eoJtrylliloVlTnoWiJCflylt~(J~o cdod
ToIXctIhooE~~d 15n a~~Ogtt~_d 1915 fndS ~d II_411mdlfrau-_ta ~n~ _~ aorlJdlytlor--shy
i[Mtf~~_c(prPflais ~IWP~__~_fOlpVN~~~~ c~VI~_~lIk1OatJltf__dillcJ~_~ovou_tJo~ltJo _ fJ~$If~~ _ IN~ IIOQIIQul_ffir_Yl rl__ W~kbodl~ClWn I64 f __bull rlMoalthgtliltspound~1L-u_ ~T_ ooIl4da~f_ 19 ~ soamp5()iltM~~ 191) _~_tu~ltUOO ~u_CltI~p
Texas Education Agency Texas Public School StudenUStaff Ethnicity and Race Data Questionnaire
The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting thedata for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity Is the person HispanicLatino (Choose only one)
D HispanicLatino - A person of Cuban Mexican Puerto Rican South or Central American or other Spanish culture or origin regardless of race
D Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more)
D American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America) and who maintains a tribal affiliation or community attachment
D Asian - A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Philippine Islands Thailand and Vietnam
D Black or African American - A person having origins in any of the black racial groups of Africa
o Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii Guam Samoa or other Pacific Islands
o White - A person having origins in any of the original peoples of Europe the Middle East or North Africa
StudentlStaff Name (please print) (ParentlG uardian)(Staff) Signature
StudentlStaff Identification Number Date
-----
-------
----
I
I
Conroe Independent School District (170902) Creighton Elementary School 106
Campus Namenumber
Students Legal Name Student ID
Please fill out the following information for all school in which this student was previously enrolled
Narne of Schoo1 School District School Numbers Dates of enrollment Grades (city amp State)
---~~~
-~~~
~~~~~
middot ROE INDEPENDENT SCHOOL DISTRICT
(0 S Almiddotlt~L
This-free and reduced meal application is included in your Kindergarten packet to give you an opportunity to apply for free or reduced meals fell your student as heshe begins the 2014-15 school vea- at Conroe ISO By filling this out and submitting it our department can determine if yourrst~dent qualifies for the free or reduced lunch and if heshe qualifies can begin eating the
first day of schooL Please submit a new application next school year when you receive it because tltis application after approval is only good (or the first 30 days ofscltool Online applications are available and can be accessed through the Child Nutrition website We ENCOURAGE all families to apply on-line as this takes about twenty-Cour hours to process unless the student is not in the system yet The online application witl open the week of August 4h Parents can apply at wwwpplvforlunchcol11
Thank You Child Nutrition
Esta carta y la solicitud de comidas gratis 0 a precio reducido vienen dentro del paquete de inscripci6n al Jardin de Niflos (Kindergarten) para que usted pueda solicitar comidas gratis 0 a precio reducido para SlI estudiante durante el cicio escolar 2014-15 en Conroe ISD Una vez que usted entregue esta sol icitlld Ilena nuestro departamento podni determinar si SlI estudiante cllmple can los requisitos para recibir comidas gratis 0 a precio reducido En caso de que su
estudiante sea aprobado ellella podnl recibir com ida desde el primer dia de clases Nota Usted deberii lIenar V devolver una nueva solicitlld en cilanto la reciba al inicio del siguiente cicio escolar porque est primera solicitlld es temporal solamente sera valida dllrante los primeros 30 dias de clase (en ClISO de aber sido aprobada) Tambien podra lIenar la solicitud en linea Busquela en nllestra pagina electr6nica en el menLI PARENTS y luego en CHILD NUTRITION Invitamos a las familias a que tramitel1 su solicitud en lfnea debido a que este tnil11ite solamente dura 24 horas a menos que el estudiante no este dado de alta en el sistema La opci6n de presentar Ia solicitud en linea se abrira durante la semana del4 de agosto Los padres podran tramitar su solicitud en wwwapplyforlul1chcom
Atentamente Departamento de Nutrici6n Infantil
2015 -2016 1--middotmiddotFamilv Survev I Campus name Campus Conroe ISO -170902 L-I---------------- shy
N arne of child ---------------____-------shy
Grade level ---__ - Date
Dear Parents
In order to better serve your children the school district would like to identify students who may qualify to receive additional educational services The information provided below will be kept confidential Please answer the following questions and return this survey to your childs school
Please provide the following information (Only if yes was answered to questions 1 amp 2 above)
Name of child ____ _ ___ Age ___ Grade ___
Father Guardian ~__ __~__~__________________~_ _____________~
Mother Guardian _ _________
Street City State Zip
Home Telephone Number __ _____~
Other Phone _____ bull--- ------ ------- shy
The Conroe Independent Schoo District does not discriminate on the basis ot race color naUana origin sex disability or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups The followlng persons have been designated to handle inquiries regatdlng these non-discrimination pofiCies
l1na IX Coordinator 3205 W Davis COnroe Texas 77304 (936l-709~7700 and the Section 504ADA Coordinator 3205 W Oavis Conroe Texas 77304 (936) 709middot7670
Community Outreach and Dropout Prevention Rodrigo Chaves DirectorNROE
INDEPENDENT SCHOOL DISTRICT 3205 West Davis bull Conroe Texas 77304-2098 ~to-amp~ 9367097759
bull bull
Conroe Independent School District 2015-2016 Application for Free and Reduced Price School Meals Return to the school cafeteria manager or mail to the Conroe ISO Child Nutrition Department
bull Use black ink Print neatly Complete one application per household 3205 West Davis Conroe TX 77302-2098
~ List ALL household members who are infants children and students up to and including grade 12 (If more space is required for additional names attach another sheet ofpaper) Homeloss
Brthdate School roster migrant Legal first name MI Legal last name MM DO yy Grade Code Child runaway
Definition of Household Member Anyone who is living with you and shares income and expenses even if not related
Children in foster care and children who meet the definition of Homeless Migrant or Runaway are eligible for free meals Read How to Apply for Free and Reduced Price School Meals for more information
~ Do any Household Members (including you) currently participate in one or more of the following assistance programs SNAP TANF FDPIR Check the appropriate box below
If you did not check one of the boxes If you Checked one of the boxes to the left write EDG number here
SNAP TANF FDPIR to the leI conplete SECTION 3 then go to SECTiON 4 (Do Not complete SECTION 3) EDG number ~ Report income for ALL Household Members (skip this step if you answered yes to SECTION 2)
A Child Income Sometimes children in the household earn income Please indicate the TOTAL income earned by all Household Members in SECTION 1 here Child income
B All Adult Household Members (including yourself) List all Household Members not listed in SECTION 1 (including yourself) even if they did not receive income For each Household Member listed if they receive income report total income for each source in whole dollars ONLY If they Do Not receive income from any WET M source check the no income box If you check the no income box yu are certifying (promising) that there is no income to report
W = Weekly E Every two weeks T Twice per month M Monthly A = Annually Public Assistance
Name of Adult Household Member (first and last) Earnings from work Fill In circle Child SupporVAlimony Fill in circleI I Please read How to 81 Apply for Free and Reduced Price School Meals for more information The Sources of Income for Children section will help
lEC ryou wijh the Child Income questions The Sources of Income for Adults section will help you with EMJ the All Adult Household Members section
bull Write total number of Household Members here Last four digits of Social Security Number (SSN)
~ Contact Information and Adult Signature I certify (promise) that all infmation on this application is true and that all income is reported I understand that this information is given in connection with the receipt of Federal funds and that school officials may verify (check) the information I am aware that if I purposely give false information my children may lose meal benefits and I may be prosecuted under applicable State and Federal laws Street address Zip Daytime phone
~-~T-T---~r---~r------------------~ ~~--- i
bull Do not fill out this part For school use only Printed name of adult completing this form xsign here Todays date
Received Reviewing officials signature Date Confirming officials Signature _ Date FollOW-Up officials signature Date
~ --~~~~~~~------
Printed name ofstuqent
Signature ofstudent
Signature ofparent
~~ --~
Date
INDEPENDENT SCHOOL DISTRICT
~to-amp~
Nombre del alumno (tetra de molde)
FIrma del alumno
Finna del padre
Fecha
I unders+anc I wilt haJ~ to pick +hi~ Ll~ -frOYl the- -9r0nt office yo emendD qyc de-bo
de leC0cter eS+Gl COplCV d~ let ofc-incc prinCipal
Dear Pltlrent or Guardian
Throughout the year different orgmizations come to Creighton Elementary wanting to assist our shldents and families with school supplies clothing and other various needs The Family Educational Rights and privacy Act a federal law that make student educational records confidentiat prohibits us from releltlsing student information to these ltlgencies without your permission Tb help us work with these groups in the most efficient way possible we ask that if you are interested in such assistance you complete and sign the form below The form should be rehlmed to Susan Fossler
These assistance programs vary from year to year Giving us permission to release your information does not automatically mean vou will receive assistance It does let ~tS knmj that you would welcome such assistance and would be willing to have your information released to these orgaJ~izations In turn these groups agree to use your information only for the purpose of their assistance program(s) It is also required that your consent for release of information be updated annually If you have a question feel free to contact your childs counselor
Sincerely
Jenny Watson Principal
Shldent name Nomlm dd (studiallte _
Parents names Nombre dc padre 0 cllcl1Ixado __
AddressDirccci611
Phone Tcitfi)ffo
Are there siblings ~Ticllc hermallitos i_- yes sl no noJ
Estimado Padre de Familia 0 encargado
Durante el ano diferentes organizaciones vienen a la escuela Creighton Elementary con eJ objetivo de
ayudar a nuestros estudiantes y sus familia res con utiles escolares ropa y otras necesidades
El Acto de Privacidad y Derechos Educacionales de la Familia una ley federal que hace que los archivos e historial educativo del eshldiante sean confidenciales nos prohibe que divulguemos informacion de estudiantes a tales organizaciones sin e1
permiso suyo Para que nos ayude a trabajar y cooperltlr con esas organizaciones de la manera
mas eficiente Ie pedimos que si LIsted esta interesado (a) en recibir dicho tipo de asistencia 0
ayuda que complete y firme la forma abajo Esta forma la debe de regresar a Susan Fossler
Estos programas de asistencia varian de ano a ano El que nos autorice a dar el permiso pedido no signifiea que recibira ayuda automaticamente Lo que nos indica es que LJsted esta dispuesto (a) a recibir dicha asistencia y que acepta que la informacion suya sea compartida con esas organizaciones Esto pennite a que estos grupos y organizaciones acuerden usar dicha informacion soJamente para e1 prop6sito del program de asistencia Tambien se requiere que renueve este permiso de divulgaci6n de informacion anualmente Si tiene alguna pregunta contacte al consejero (a) de su hijo (a)
Sincerely
Jenny Watson Prillcipal
If yes names and ages of siblings I Nomnc y cdad de los hCrl11111 itos
Parent signature Firma del padre Date I Fecha
Conloe Independent School District Student Residency Questionnaire
The information on this form is required to meet the law known as the McKinney-Vento Act 42 USc 11434a(2) which is also known as Title X Part C of the No Child Left Behind Act The answers you give will help the school determine the services the student may be eligible to receive
Presenting a false record or falsifying records is an offense IInder Section 37 JO Penal code and enrollment of the child under false documents subjects the person 10 liability for tuition or other costs TEe Sec 25 002 (3)(d)
Name of Student ___________----_______________ Gender 0 Male 0 Female
Last First Middle
Birth Date __-----_--_ CampusCreighton Elementary Grade ____ Student Month Day Year
Check the box that best describes with whom the student resides (Please note legal guardianship may be granted only by a court students living on their own or with friends or relatives who do not have legal guardianship are allowed to enroll in and attend schoo The school cannot require proofofguardianship for enrollment or continued attendance)
o Parent(s)
o Legal Guardians(s)
o Caregiver(s) who are not legal guardian(s) (Examples friends relatives parents offriends etc) o Other _________________________________________________________________
Name of person with whom student resides ___________________________~
Home Phone ___________ Cell Phone _________ Other Emergency _________
Length of Time at Previous
Name of the school where student is enrolled or in which student is attempting to enroll ____________
_ ~~__________ Last School Attended ______________Last District
Please check only one box that best describes where the student is presently living
o In my own home or apartment in Section 8 housing or in military housing with parent(s) legal guardian(s) or caregiver(s) (ifyou checked this box check one or both ofthe boxes below ifapplicable) (CODE=N)
o My home has no electricity (CODE=U)
o My home has no running water (CODE=U)
o In the home of a friend or relative because I lost my housing (examples fire flood lost job divorce domestic violence kicked out by parents parent in military and was deployed parent(s) injai etc (CODE=D)
o In a shelter becallse I do not have permanent hOllsing (examples living in a family shelter domestic violence shelter childrenyouth shelter FEMA housing) (CODE=S)
o In transitional housing (housing that is available for a specific length oftime only and is partly or completely paid for by a church a nonprofit organization or another organization) (CODE=S)
o In a hotel or motel (examples because ofeconomic hardship eviction cannot get deposits for permanent home floodfire hurricane efc) (CODE=HM)
o In a tent car van abandoned building on the streets at a campground in the park or other unsheltered location (CODE=U)
o None of the above describe my present living situation Briefly describe your situation _________~
Factors contributing to the students current living situation (check all that apply)
o Natural disaster
0 Tornado storm flood etc
o Hurricane name
o Fire prairie forest grass lightning strike etc
o Family issues such as divorce domestic violence kicked out by parents student left due to family conflict etc
o Home issues such as lack of electricity water heat adequate home repair due to lack of funds overcrowding mold etc
o Military Parentguardian deployed injured or killed in action
o Incarceration of parentguardian
o Incapacitation of parent or guardian due to health mental health drugsalcohol or other factors
o Home fire not due to natural causes (i e faulty equipmentappl iancesWiring furnace stove fireplace etc)
o Economic hardship
o Loss of job resulting in inability to pay rent or mortgage
o Income from part-time or low paying job does not cover cost of housing in the area
o Loss of mortgage including loss of mortgage of landlord if studentstudents family is renting
o Eviction record andor inability to produce deposits for rent or utilities
o High medical bills that leave little or no money for housing
o Lack of affordable housing in the area
o Minor student unable to afford housing on my own
o None of the above describe the main reasons for my present living situation Briefly explain the contributing factors _______________________________________
Please provide the following information for school-age siblings (brothers andor sisters) of the student
Name Grade Level School District
Signature of ParentLcgal GuardianCaregiverlUnaccompanied Student Date
For School Use Only I certify the above named student qualifies for the Child Nutrition Program under the provisions of the McKinney-Vento Act
McKinney-Vento Liaison Signature Date
New Student Information Conroe Independent School District
Creighton Elementary SchoolCampus _________________________________________________ Date ___________________
Students name _____~~__ ~____~__________ ~____~______ _______ __ ____ _0-______ Age ____
Date of birth ________ Grade _____ Student ID IImiddot ____ ____________
Has your child ever been enrolled in a Conroe Independent School District school before
1fyes name of school(s
Has your child ever repeated a
1fyes which grade(s)
Check Yes or No to indicate whe~er your child has ever received service~ in any of the following programs
Special Education including Speech
Special Reading or Math program (not in Special Education)
Migrant program
BilingualESL program
Gifted and Talented program
Section 504
Please note that official testing or other academic documentation may be required for your child to qualify in the Conroe Independent School District for any of the special programs marked Yes
FOR OFFICE ONLY
Entry
Teacher -__----------shy TRex
Cum Request _________
Info Updated _____ ___
lE1MS 706
Name of student (Nombre del estudiante) _______________________
Address (Domicilio)
ID (Numero de identificaci6n) _~____ Grade (Grado) ___
This fonn should be filled in and signed by parent or guardian for pre-kindergarten-8 students or by the student in grades 9-12 (Este formulari 0 debe completarlo y firmarlo el padremadre 0 tutor legal de los estudiantes que cursan los grados de prekindergarten a octavo 0 por el estudiante en los gmdos superiores)
Refer to Chapter 89 1215
What language is spoken in your home most of the time ~Cual es el idioma que mas se habla en su
What language does your child speak most of the time ~Cual es el idioma que mas habla su hijoa _________________
What language does your child speak and understand best zQue idioma habla y entiende mejor su hijoa _________________
Has your child lived outside the United States for two or more consecutive years zHa vivido su hijoa fuera de los Estados Unidos por dos 0 mas anos consecutivos C Yes No
How long has your child lived in the United States iCwinto tiempo ha vivido su hijoa en los Estados Unidos _________________
Has your sondaughter changed school districts within the last three years LSe ha cambiado su hljoa de distrito escolar durante los ultimos tres aiios 0 Yes 0 No
Did your child attend school regularly in the United States or in hisher native country LAsisti6 su hijoa con regularidad ala escuela en los Estados Unidos 0 palS nativo D Yes 0 No
Yes my child attended school regularly in the United States or in my country of origin and finished the previous grade Si mi hijoa asisti6 con regularidad ala escuela en los Estados Unidos 0 en mi pais de origen y termin6 el grado inmediato anterior
o No my child did not attend school regularly in the United States or in my country of origin and did not finish the previous grade as stated below (Specify the grade month and year your child failed to attend school Do not include if absences were less than a month) No mi hijoa no asisti6 con regularidad a la escuela en los Estados Unidos ni en mi pais de origen yno termin6 el grado inmediato anterior segun se especifica (Especifique el grado mes y ano cuando S1-l hijoa no asisti6 a la escuela No incluya este dato si falt6 a la escuela menos de un mes)
__-__---shy---------~----
Signature of parent (Firma del o tutor legal)
CISDmiddot17 (9111) White copymiddot Cumulative Folder Yellow copymiddot Green Foldermiddot Pink copy AI-risk Counselor lCavh~t~OI~lonQ IVI_~~pl)oamprcI~XJIIrvt~ltrtt1lII_apy~J 81IJ1ltn-Irf~ptC9 UocUgtJI II-laquoJ~IIIlaquon ~mgtIlOYInD-eoJtrylliloVlTnoWiJCflylt~(J~o cdod
ToIXctIhooE~~d 15n a~~Ogtt~_d 1915 fndS ~d II_411mdlfrau-_ta ~n~ _~ aorlJdlytlor--shy
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Texas Education Agency Texas Public School StudenUStaff Ethnicity and Race Data Questionnaire
The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting thedata for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity Is the person HispanicLatino (Choose only one)
D HispanicLatino - A person of Cuban Mexican Puerto Rican South or Central American or other Spanish culture or origin regardless of race
D Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more)
D American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America) and who maintains a tribal affiliation or community attachment
D Asian - A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Philippine Islands Thailand and Vietnam
D Black or African American - A person having origins in any of the black racial groups of Africa
o Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii Guam Samoa or other Pacific Islands
o White - A person having origins in any of the original peoples of Europe the Middle East or North Africa
StudentlStaff Name (please print) (ParentlG uardian)(Staff) Signature
StudentlStaff Identification Number Date
-----
-------
----
I
I
Conroe Independent School District (170902) Creighton Elementary School 106
Campus Namenumber
Students Legal Name Student ID
Please fill out the following information for all school in which this student was previously enrolled
Narne of Schoo1 School District School Numbers Dates of enrollment Grades (city amp State)
---~~~
-~~~
~~~~~
middot ROE INDEPENDENT SCHOOL DISTRICT
(0 S Almiddotlt~L
This-free and reduced meal application is included in your Kindergarten packet to give you an opportunity to apply for free or reduced meals fell your student as heshe begins the 2014-15 school vea- at Conroe ISO By filling this out and submitting it our department can determine if yourrst~dent qualifies for the free or reduced lunch and if heshe qualifies can begin eating the
first day of schooL Please submit a new application next school year when you receive it because tltis application after approval is only good (or the first 30 days ofscltool Online applications are available and can be accessed through the Child Nutrition website We ENCOURAGE all families to apply on-line as this takes about twenty-Cour hours to process unless the student is not in the system yet The online application witl open the week of August 4h Parents can apply at wwwpplvforlunchcol11
Thank You Child Nutrition
Esta carta y la solicitud de comidas gratis 0 a precio reducido vienen dentro del paquete de inscripci6n al Jardin de Niflos (Kindergarten) para que usted pueda solicitar comidas gratis 0 a precio reducido para SlI estudiante durante el cicio escolar 2014-15 en Conroe ISD Una vez que usted entregue esta sol icitlld Ilena nuestro departamento podni determinar si SlI estudiante cllmple can los requisitos para recibir comidas gratis 0 a precio reducido En caso de que su
estudiante sea aprobado ellella podnl recibir com ida desde el primer dia de clases Nota Usted deberii lIenar V devolver una nueva solicitlld en cilanto la reciba al inicio del siguiente cicio escolar porque est primera solicitlld es temporal solamente sera valida dllrante los primeros 30 dias de clase (en ClISO de aber sido aprobada) Tambien podra lIenar la solicitud en linea Busquela en nllestra pagina electr6nica en el menLI PARENTS y luego en CHILD NUTRITION Invitamos a las familias a que tramitel1 su solicitud en lfnea debido a que este tnil11ite solamente dura 24 horas a menos que el estudiante no este dado de alta en el sistema La opci6n de presentar Ia solicitud en linea se abrira durante la semana del4 de agosto Los padres podran tramitar su solicitud en wwwapplyforlul1chcom
Atentamente Departamento de Nutrici6n Infantil
2015 -2016 1--middotmiddotFamilv Survev I Campus name Campus Conroe ISO -170902 L-I---------------- shy
N arne of child ---------------____-------shy
Grade level ---__ - Date
Dear Parents
In order to better serve your children the school district would like to identify students who may qualify to receive additional educational services The information provided below will be kept confidential Please answer the following questions and return this survey to your childs school
Please provide the following information (Only if yes was answered to questions 1 amp 2 above)
Name of child ____ _ ___ Age ___ Grade ___
Father Guardian ~__ __~__~__________________~_ _____________~
Mother Guardian _ _________
Street City State Zip
Home Telephone Number __ _____~
Other Phone _____ bull--- ------ ------- shy
The Conroe Independent Schoo District does not discriminate on the basis ot race color naUana origin sex disability or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups The followlng persons have been designated to handle inquiries regatdlng these non-discrimination pofiCies
l1na IX Coordinator 3205 W Davis COnroe Texas 77304 (936l-709~7700 and the Section 504ADA Coordinator 3205 W Oavis Conroe Texas 77304 (936) 709middot7670
Community Outreach and Dropout Prevention Rodrigo Chaves DirectorNROE
INDEPENDENT SCHOOL DISTRICT 3205 West Davis bull Conroe Texas 77304-2098 ~to-amp~ 9367097759
bull bull
Conroe Independent School District 2015-2016 Application for Free and Reduced Price School Meals Return to the school cafeteria manager or mail to the Conroe ISO Child Nutrition Department
bull Use black ink Print neatly Complete one application per household 3205 West Davis Conroe TX 77302-2098
~ List ALL household members who are infants children and students up to and including grade 12 (If more space is required for additional names attach another sheet ofpaper) Homeloss
Brthdate School roster migrant Legal first name MI Legal last name MM DO yy Grade Code Child runaway
Definition of Household Member Anyone who is living with you and shares income and expenses even if not related
Children in foster care and children who meet the definition of Homeless Migrant or Runaway are eligible for free meals Read How to Apply for Free and Reduced Price School Meals for more information
~ Do any Household Members (including you) currently participate in one or more of the following assistance programs SNAP TANF FDPIR Check the appropriate box below
If you did not check one of the boxes If you Checked one of the boxes to the left write EDG number here
SNAP TANF FDPIR to the leI conplete SECTION 3 then go to SECTiON 4 (Do Not complete SECTION 3) EDG number ~ Report income for ALL Household Members (skip this step if you answered yes to SECTION 2)
A Child Income Sometimes children in the household earn income Please indicate the TOTAL income earned by all Household Members in SECTION 1 here Child income
B All Adult Household Members (including yourself) List all Household Members not listed in SECTION 1 (including yourself) even if they did not receive income For each Household Member listed if they receive income report total income for each source in whole dollars ONLY If they Do Not receive income from any WET M source check the no income box If you check the no income box yu are certifying (promising) that there is no income to report
W = Weekly E Every two weeks T Twice per month M Monthly A = Annually Public Assistance
Name of Adult Household Member (first and last) Earnings from work Fill In circle Child SupporVAlimony Fill in circleI I Please read How to 81 Apply for Free and Reduced Price School Meals for more information The Sources of Income for Children section will help
lEC ryou wijh the Child Income questions The Sources of Income for Adults section will help you with EMJ the All Adult Household Members section
bull Write total number of Household Members here Last four digits of Social Security Number (SSN)
~ Contact Information and Adult Signature I certify (promise) that all infmation on this application is true and that all income is reported I understand that this information is given in connection with the receipt of Federal funds and that school officials may verify (check) the information I am aware that if I purposely give false information my children may lose meal benefits and I may be prosecuted under applicable State and Federal laws Street address Zip Daytime phone
~-~T-T---~r---~r------------------~ ~~--- i
bull Do not fill out this part For school use only Printed name of adult completing this form xsign here Todays date
Received Reviewing officials signature Date Confirming officials Signature _ Date FollOW-Up officials signature Date
~ --~~~~~~~------
Printed name ofstuqent
Signature ofstudent
Signature ofparent
~~ --~
Date
INDEPENDENT SCHOOL DISTRICT
~to-amp~
Nombre del alumno (tetra de molde)
FIrma del alumno
Finna del padre
Fecha
I unders+anc I wilt haJ~ to pick +hi~ Ll~ -frOYl the- -9r0nt office yo emendD qyc de-bo
de leC0cter eS+Gl COplCV d~ let ofc-incc prinCipal
Dear Pltlrent or Guardian
Throughout the year different orgmizations come to Creighton Elementary wanting to assist our shldents and families with school supplies clothing and other various needs The Family Educational Rights and privacy Act a federal law that make student educational records confidentiat prohibits us from releltlsing student information to these ltlgencies without your permission Tb help us work with these groups in the most efficient way possible we ask that if you are interested in such assistance you complete and sign the form below The form should be rehlmed to Susan Fossler
These assistance programs vary from year to year Giving us permission to release your information does not automatically mean vou will receive assistance It does let ~tS knmj that you would welcome such assistance and would be willing to have your information released to these orgaJ~izations In turn these groups agree to use your information only for the purpose of their assistance program(s) It is also required that your consent for release of information be updated annually If you have a question feel free to contact your childs counselor
Sincerely
Jenny Watson Principal
Shldent name Nomlm dd (studiallte _
Parents names Nombre dc padre 0 cllcl1Ixado __
AddressDirccci611
Phone Tcitfi)ffo
Are there siblings ~Ticllc hermallitos i_- yes sl no noJ
Estimado Padre de Familia 0 encargado
Durante el ano diferentes organizaciones vienen a la escuela Creighton Elementary con eJ objetivo de
ayudar a nuestros estudiantes y sus familia res con utiles escolares ropa y otras necesidades
El Acto de Privacidad y Derechos Educacionales de la Familia una ley federal que hace que los archivos e historial educativo del eshldiante sean confidenciales nos prohibe que divulguemos informacion de estudiantes a tales organizaciones sin e1
permiso suyo Para que nos ayude a trabajar y cooperltlr con esas organizaciones de la manera
mas eficiente Ie pedimos que si LIsted esta interesado (a) en recibir dicho tipo de asistencia 0
ayuda que complete y firme la forma abajo Esta forma la debe de regresar a Susan Fossler
Estos programas de asistencia varian de ano a ano El que nos autorice a dar el permiso pedido no signifiea que recibira ayuda automaticamente Lo que nos indica es que LJsted esta dispuesto (a) a recibir dicha asistencia y que acepta que la informacion suya sea compartida con esas organizaciones Esto pennite a que estos grupos y organizaciones acuerden usar dicha informacion soJamente para e1 prop6sito del program de asistencia Tambien se requiere que renueve este permiso de divulgaci6n de informacion anualmente Si tiene alguna pregunta contacte al consejero (a) de su hijo (a)
Sincerely
Jenny Watson Prillcipal
If yes names and ages of siblings I Nomnc y cdad de los hCrl11111 itos
Parent signature Firma del padre Date I Fecha
o In transitional housing (housing that is available for a specific length oftime only and is partly or completely paid for by a church a nonprofit organization or another organization) (CODE=S)
o In a hotel or motel (examples because ofeconomic hardship eviction cannot get deposits for permanent home floodfire hurricane efc) (CODE=HM)
o In a tent car van abandoned building on the streets at a campground in the park or other unsheltered location (CODE=U)
o None of the above describe my present living situation Briefly describe your situation _________~
Factors contributing to the students current living situation (check all that apply)
o Natural disaster
0 Tornado storm flood etc
o Hurricane name
o Fire prairie forest grass lightning strike etc
o Family issues such as divorce domestic violence kicked out by parents student left due to family conflict etc
o Home issues such as lack of electricity water heat adequate home repair due to lack of funds overcrowding mold etc
o Military Parentguardian deployed injured or killed in action
o Incarceration of parentguardian
o Incapacitation of parent or guardian due to health mental health drugsalcohol or other factors
o Home fire not due to natural causes (i e faulty equipmentappl iancesWiring furnace stove fireplace etc)
o Economic hardship
o Loss of job resulting in inability to pay rent or mortgage
o Income from part-time or low paying job does not cover cost of housing in the area
o Loss of mortgage including loss of mortgage of landlord if studentstudents family is renting
o Eviction record andor inability to produce deposits for rent or utilities
o High medical bills that leave little or no money for housing
o Lack of affordable housing in the area
o Minor student unable to afford housing on my own
o None of the above describe the main reasons for my present living situation Briefly explain the contributing factors _______________________________________
Please provide the following information for school-age siblings (brothers andor sisters) of the student
Name Grade Level School District
Signature of ParentLcgal GuardianCaregiverlUnaccompanied Student Date
For School Use Only I certify the above named student qualifies for the Child Nutrition Program under the provisions of the McKinney-Vento Act
McKinney-Vento Liaison Signature Date
New Student Information Conroe Independent School District
Creighton Elementary SchoolCampus _________________________________________________ Date ___________________
Students name _____~~__ ~____~__________ ~____~______ _______ __ ____ _0-______ Age ____
Date of birth ________ Grade _____ Student ID IImiddot ____ ____________
Has your child ever been enrolled in a Conroe Independent School District school before
1fyes name of school(s
Has your child ever repeated a
1fyes which grade(s)
Check Yes or No to indicate whe~er your child has ever received service~ in any of the following programs
Special Education including Speech
Special Reading or Math program (not in Special Education)
Migrant program
BilingualESL program
Gifted and Talented program
Section 504
Please note that official testing or other academic documentation may be required for your child to qualify in the Conroe Independent School District for any of the special programs marked Yes
FOR OFFICE ONLY
Entry
Teacher -__----------shy TRex
Cum Request _________
Info Updated _____ ___
lE1MS 706
Name of student (Nombre del estudiante) _______________________
Address (Domicilio)
ID (Numero de identificaci6n) _~____ Grade (Grado) ___
This fonn should be filled in and signed by parent or guardian for pre-kindergarten-8 students or by the student in grades 9-12 (Este formulari 0 debe completarlo y firmarlo el padremadre 0 tutor legal de los estudiantes que cursan los grados de prekindergarten a octavo 0 por el estudiante en los gmdos superiores)
Refer to Chapter 89 1215
What language is spoken in your home most of the time ~Cual es el idioma que mas se habla en su
What language does your child speak most of the time ~Cual es el idioma que mas habla su hijoa _________________
What language does your child speak and understand best zQue idioma habla y entiende mejor su hijoa _________________
Has your child lived outside the United States for two or more consecutive years zHa vivido su hijoa fuera de los Estados Unidos por dos 0 mas anos consecutivos C Yes No
How long has your child lived in the United States iCwinto tiempo ha vivido su hijoa en los Estados Unidos _________________
Has your sondaughter changed school districts within the last three years LSe ha cambiado su hljoa de distrito escolar durante los ultimos tres aiios 0 Yes 0 No
Did your child attend school regularly in the United States or in hisher native country LAsisti6 su hijoa con regularidad ala escuela en los Estados Unidos 0 palS nativo D Yes 0 No
Yes my child attended school regularly in the United States or in my country of origin and finished the previous grade Si mi hijoa asisti6 con regularidad ala escuela en los Estados Unidos 0 en mi pais de origen y termin6 el grado inmediato anterior
o No my child did not attend school regularly in the United States or in my country of origin and did not finish the previous grade as stated below (Specify the grade month and year your child failed to attend school Do not include if absences were less than a month) No mi hijoa no asisti6 con regularidad a la escuela en los Estados Unidos ni en mi pais de origen yno termin6 el grado inmediato anterior segun se especifica (Especifique el grado mes y ano cuando S1-l hijoa no asisti6 a la escuela No incluya este dato si falt6 a la escuela menos de un mes)
__-__---shy---------~----
Signature of parent (Firma del o tutor legal)
CISDmiddot17 (9111) White copymiddot Cumulative Folder Yellow copymiddot Green Foldermiddot Pink copy AI-risk Counselor lCavh~t~OI~lonQ IVI_~~pl)oamprcI~XJIIrvt~ltrtt1lII_apy~J 81IJ1ltn-Irf~ptC9 UocUgtJI II-laquoJ~IIIlaquon ~mgtIlOYInD-eoJtrylliloVlTnoWiJCflylt~(J~o cdod
ToIXctIhooE~~d 15n a~~Ogtt~_d 1915 fndS ~d II_411mdlfrau-_ta ~n~ _~ aorlJdlytlor--shy
i[Mtf~~_c(prPflais ~IWP~__~_fOlpVN~~~~ c~VI~_~lIk1OatJltf__dillcJ~_~ovou_tJo~ltJo _ fJ~$If~~ _ IN~ IIOQIIQul_ffir_Yl rl__ W~kbodl~ClWn I64 f __bull rlMoalthgtliltspound~1L-u_ ~T_ ooIl4da~f_ 19 ~ soamp5()iltM~~ 191) _~_tu~ltUOO ~u_CltI~p
Texas Education Agency Texas Public School StudenUStaff Ethnicity and Race Data Questionnaire
The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting thedata for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity Is the person HispanicLatino (Choose only one)
D HispanicLatino - A person of Cuban Mexican Puerto Rican South or Central American or other Spanish culture or origin regardless of race
D Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more)
D American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America) and who maintains a tribal affiliation or community attachment
D Asian - A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Philippine Islands Thailand and Vietnam
D Black or African American - A person having origins in any of the black racial groups of Africa
o Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii Guam Samoa or other Pacific Islands
o White - A person having origins in any of the original peoples of Europe the Middle East or North Africa
StudentlStaff Name (please print) (ParentlG uardian)(Staff) Signature
StudentlStaff Identification Number Date
-----
-------
----
I
I
Conroe Independent School District (170902) Creighton Elementary School 106
Campus Namenumber
Students Legal Name Student ID
Please fill out the following information for all school in which this student was previously enrolled
Narne of Schoo1 School District School Numbers Dates of enrollment Grades (city amp State)
---~~~
-~~~
~~~~~
middot ROE INDEPENDENT SCHOOL DISTRICT
(0 S Almiddotlt~L
This-free and reduced meal application is included in your Kindergarten packet to give you an opportunity to apply for free or reduced meals fell your student as heshe begins the 2014-15 school vea- at Conroe ISO By filling this out and submitting it our department can determine if yourrst~dent qualifies for the free or reduced lunch and if heshe qualifies can begin eating the
first day of schooL Please submit a new application next school year when you receive it because tltis application after approval is only good (or the first 30 days ofscltool Online applications are available and can be accessed through the Child Nutrition website We ENCOURAGE all families to apply on-line as this takes about twenty-Cour hours to process unless the student is not in the system yet The online application witl open the week of August 4h Parents can apply at wwwpplvforlunchcol11
Thank You Child Nutrition
Esta carta y la solicitud de comidas gratis 0 a precio reducido vienen dentro del paquete de inscripci6n al Jardin de Niflos (Kindergarten) para que usted pueda solicitar comidas gratis 0 a precio reducido para SlI estudiante durante el cicio escolar 2014-15 en Conroe ISD Una vez que usted entregue esta sol icitlld Ilena nuestro departamento podni determinar si SlI estudiante cllmple can los requisitos para recibir comidas gratis 0 a precio reducido En caso de que su
estudiante sea aprobado ellella podnl recibir com ida desde el primer dia de clases Nota Usted deberii lIenar V devolver una nueva solicitlld en cilanto la reciba al inicio del siguiente cicio escolar porque est primera solicitlld es temporal solamente sera valida dllrante los primeros 30 dias de clase (en ClISO de aber sido aprobada) Tambien podra lIenar la solicitud en linea Busquela en nllestra pagina electr6nica en el menLI PARENTS y luego en CHILD NUTRITION Invitamos a las familias a que tramitel1 su solicitud en lfnea debido a que este tnil11ite solamente dura 24 horas a menos que el estudiante no este dado de alta en el sistema La opci6n de presentar Ia solicitud en linea se abrira durante la semana del4 de agosto Los padres podran tramitar su solicitud en wwwapplyforlul1chcom
Atentamente Departamento de Nutrici6n Infantil
2015 -2016 1--middotmiddotFamilv Survev I Campus name Campus Conroe ISO -170902 L-I---------------- shy
N arne of child ---------------____-------shy
Grade level ---__ - Date
Dear Parents
In order to better serve your children the school district would like to identify students who may qualify to receive additional educational services The information provided below will be kept confidential Please answer the following questions and return this survey to your childs school
Please provide the following information (Only if yes was answered to questions 1 amp 2 above)
Name of child ____ _ ___ Age ___ Grade ___
Father Guardian ~__ __~__~__________________~_ _____________~
Mother Guardian _ _________
Street City State Zip
Home Telephone Number __ _____~
Other Phone _____ bull--- ------ ------- shy
The Conroe Independent Schoo District does not discriminate on the basis ot race color naUana origin sex disability or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups The followlng persons have been designated to handle inquiries regatdlng these non-discrimination pofiCies
l1na IX Coordinator 3205 W Davis COnroe Texas 77304 (936l-709~7700 and the Section 504ADA Coordinator 3205 W Oavis Conroe Texas 77304 (936) 709middot7670
Community Outreach and Dropout Prevention Rodrigo Chaves DirectorNROE
INDEPENDENT SCHOOL DISTRICT 3205 West Davis bull Conroe Texas 77304-2098 ~to-amp~ 9367097759
bull bull
Conroe Independent School District 2015-2016 Application for Free and Reduced Price School Meals Return to the school cafeteria manager or mail to the Conroe ISO Child Nutrition Department
bull Use black ink Print neatly Complete one application per household 3205 West Davis Conroe TX 77302-2098
~ List ALL household members who are infants children and students up to and including grade 12 (If more space is required for additional names attach another sheet ofpaper) Homeloss
Brthdate School roster migrant Legal first name MI Legal last name MM DO yy Grade Code Child runaway
Definition of Household Member Anyone who is living with you and shares income and expenses even if not related
Children in foster care and children who meet the definition of Homeless Migrant or Runaway are eligible for free meals Read How to Apply for Free and Reduced Price School Meals for more information
~ Do any Household Members (including you) currently participate in one or more of the following assistance programs SNAP TANF FDPIR Check the appropriate box below
If you did not check one of the boxes If you Checked one of the boxes to the left write EDG number here
SNAP TANF FDPIR to the leI conplete SECTION 3 then go to SECTiON 4 (Do Not complete SECTION 3) EDG number ~ Report income for ALL Household Members (skip this step if you answered yes to SECTION 2)
A Child Income Sometimes children in the household earn income Please indicate the TOTAL income earned by all Household Members in SECTION 1 here Child income
B All Adult Household Members (including yourself) List all Household Members not listed in SECTION 1 (including yourself) even if they did not receive income For each Household Member listed if they receive income report total income for each source in whole dollars ONLY If they Do Not receive income from any WET M source check the no income box If you check the no income box yu are certifying (promising) that there is no income to report
W = Weekly E Every two weeks T Twice per month M Monthly A = Annually Public Assistance
Name of Adult Household Member (first and last) Earnings from work Fill In circle Child SupporVAlimony Fill in circleI I Please read How to 81 Apply for Free and Reduced Price School Meals for more information The Sources of Income for Children section will help
lEC ryou wijh the Child Income questions The Sources of Income for Adults section will help you with EMJ the All Adult Household Members section
bull Write total number of Household Members here Last four digits of Social Security Number (SSN)
~ Contact Information and Adult Signature I certify (promise) that all infmation on this application is true and that all income is reported I understand that this information is given in connection with the receipt of Federal funds and that school officials may verify (check) the information I am aware that if I purposely give false information my children may lose meal benefits and I may be prosecuted under applicable State and Federal laws Street address Zip Daytime phone
~-~T-T---~r---~r------------------~ ~~--- i
bull Do not fill out this part For school use only Printed name of adult completing this form xsign here Todays date
Received Reviewing officials signature Date Confirming officials Signature _ Date FollOW-Up officials signature Date
~ --~~~~~~~------
Printed name ofstuqent
Signature ofstudent
Signature ofparent
~~ --~
Date
INDEPENDENT SCHOOL DISTRICT
~to-amp~
Nombre del alumno (tetra de molde)
FIrma del alumno
Finna del padre
Fecha
I unders+anc I wilt haJ~ to pick +hi~ Ll~ -frOYl the- -9r0nt office yo emendD qyc de-bo
de leC0cter eS+Gl COplCV d~ let ofc-incc prinCipal
Dear Pltlrent or Guardian
Throughout the year different orgmizations come to Creighton Elementary wanting to assist our shldents and families with school supplies clothing and other various needs The Family Educational Rights and privacy Act a federal law that make student educational records confidentiat prohibits us from releltlsing student information to these ltlgencies without your permission Tb help us work with these groups in the most efficient way possible we ask that if you are interested in such assistance you complete and sign the form below The form should be rehlmed to Susan Fossler
These assistance programs vary from year to year Giving us permission to release your information does not automatically mean vou will receive assistance It does let ~tS knmj that you would welcome such assistance and would be willing to have your information released to these orgaJ~izations In turn these groups agree to use your information only for the purpose of their assistance program(s) It is also required that your consent for release of information be updated annually If you have a question feel free to contact your childs counselor
Sincerely
Jenny Watson Principal
Shldent name Nomlm dd (studiallte _
Parents names Nombre dc padre 0 cllcl1Ixado __
AddressDirccci611
Phone Tcitfi)ffo
Are there siblings ~Ticllc hermallitos i_- yes sl no noJ
Estimado Padre de Familia 0 encargado
Durante el ano diferentes organizaciones vienen a la escuela Creighton Elementary con eJ objetivo de
ayudar a nuestros estudiantes y sus familia res con utiles escolares ropa y otras necesidades
El Acto de Privacidad y Derechos Educacionales de la Familia una ley federal que hace que los archivos e historial educativo del eshldiante sean confidenciales nos prohibe que divulguemos informacion de estudiantes a tales organizaciones sin e1
permiso suyo Para que nos ayude a trabajar y cooperltlr con esas organizaciones de la manera
mas eficiente Ie pedimos que si LIsted esta interesado (a) en recibir dicho tipo de asistencia 0
ayuda que complete y firme la forma abajo Esta forma la debe de regresar a Susan Fossler
Estos programas de asistencia varian de ano a ano El que nos autorice a dar el permiso pedido no signifiea que recibira ayuda automaticamente Lo que nos indica es que LJsted esta dispuesto (a) a recibir dicha asistencia y que acepta que la informacion suya sea compartida con esas organizaciones Esto pennite a que estos grupos y organizaciones acuerden usar dicha informacion soJamente para e1 prop6sito del program de asistencia Tambien se requiere que renueve este permiso de divulgaci6n de informacion anualmente Si tiene alguna pregunta contacte al consejero (a) de su hijo (a)
Sincerely
Jenny Watson Prillcipal
If yes names and ages of siblings I Nomnc y cdad de los hCrl11111 itos
Parent signature Firma del padre Date I Fecha
New Student Information Conroe Independent School District
Creighton Elementary SchoolCampus _________________________________________________ Date ___________________
Students name _____~~__ ~____~__________ ~____~______ _______ __ ____ _0-______ Age ____
Date of birth ________ Grade _____ Student ID IImiddot ____ ____________
Has your child ever been enrolled in a Conroe Independent School District school before
1fyes name of school(s
Has your child ever repeated a
1fyes which grade(s)
Check Yes or No to indicate whe~er your child has ever received service~ in any of the following programs
Special Education including Speech
Special Reading or Math program (not in Special Education)
Migrant program
BilingualESL program
Gifted and Talented program
Section 504
Please note that official testing or other academic documentation may be required for your child to qualify in the Conroe Independent School District for any of the special programs marked Yes
FOR OFFICE ONLY
Entry
Teacher -__----------shy TRex
Cum Request _________
Info Updated _____ ___
lE1MS 706
Name of student (Nombre del estudiante) _______________________
Address (Domicilio)
ID (Numero de identificaci6n) _~____ Grade (Grado) ___
This fonn should be filled in and signed by parent or guardian for pre-kindergarten-8 students or by the student in grades 9-12 (Este formulari 0 debe completarlo y firmarlo el padremadre 0 tutor legal de los estudiantes que cursan los grados de prekindergarten a octavo 0 por el estudiante en los gmdos superiores)
Refer to Chapter 89 1215
What language is spoken in your home most of the time ~Cual es el idioma que mas se habla en su
What language does your child speak most of the time ~Cual es el idioma que mas habla su hijoa _________________
What language does your child speak and understand best zQue idioma habla y entiende mejor su hijoa _________________
Has your child lived outside the United States for two or more consecutive years zHa vivido su hijoa fuera de los Estados Unidos por dos 0 mas anos consecutivos C Yes No
How long has your child lived in the United States iCwinto tiempo ha vivido su hijoa en los Estados Unidos _________________
Has your sondaughter changed school districts within the last three years LSe ha cambiado su hljoa de distrito escolar durante los ultimos tres aiios 0 Yes 0 No
Did your child attend school regularly in the United States or in hisher native country LAsisti6 su hijoa con regularidad ala escuela en los Estados Unidos 0 palS nativo D Yes 0 No
Yes my child attended school regularly in the United States or in my country of origin and finished the previous grade Si mi hijoa asisti6 con regularidad ala escuela en los Estados Unidos 0 en mi pais de origen y termin6 el grado inmediato anterior
o No my child did not attend school regularly in the United States or in my country of origin and did not finish the previous grade as stated below (Specify the grade month and year your child failed to attend school Do not include if absences were less than a month) No mi hijoa no asisti6 con regularidad a la escuela en los Estados Unidos ni en mi pais de origen yno termin6 el grado inmediato anterior segun se especifica (Especifique el grado mes y ano cuando S1-l hijoa no asisti6 a la escuela No incluya este dato si falt6 a la escuela menos de un mes)
__-__---shy---------~----
Signature of parent (Firma del o tutor legal)
CISDmiddot17 (9111) White copymiddot Cumulative Folder Yellow copymiddot Green Foldermiddot Pink copy AI-risk Counselor lCavh~t~OI~lonQ IVI_~~pl)oamprcI~XJIIrvt~ltrtt1lII_apy~J 81IJ1ltn-Irf~ptC9 UocUgtJI II-laquoJ~IIIlaquon ~mgtIlOYInD-eoJtrylliloVlTnoWiJCflylt~(J~o cdod
ToIXctIhooE~~d 15n a~~Ogtt~_d 1915 fndS ~d II_411mdlfrau-_ta ~n~ _~ aorlJdlytlor--shy
i[Mtf~~_c(prPflais ~IWP~__~_fOlpVN~~~~ c~VI~_~lIk1OatJltf__dillcJ~_~ovou_tJo~ltJo _ fJ~$If~~ _ IN~ IIOQIIQul_ffir_Yl rl__ W~kbodl~ClWn I64 f __bull rlMoalthgtliltspound~1L-u_ ~T_ ooIl4da~f_ 19 ~ soamp5()iltM~~ 191) _~_tu~ltUOO ~u_CltI~p
Texas Education Agency Texas Public School StudenUStaff Ethnicity and Race Data Questionnaire
The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting thedata for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity Is the person HispanicLatino (Choose only one)
D HispanicLatino - A person of Cuban Mexican Puerto Rican South or Central American or other Spanish culture or origin regardless of race
D Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more)
D American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America) and who maintains a tribal affiliation or community attachment
D Asian - A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Philippine Islands Thailand and Vietnam
D Black or African American - A person having origins in any of the black racial groups of Africa
o Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii Guam Samoa or other Pacific Islands
o White - A person having origins in any of the original peoples of Europe the Middle East or North Africa
StudentlStaff Name (please print) (ParentlG uardian)(Staff) Signature
StudentlStaff Identification Number Date
-----
-------
----
I
I
Conroe Independent School District (170902) Creighton Elementary School 106
Campus Namenumber
Students Legal Name Student ID
Please fill out the following information for all school in which this student was previously enrolled
Narne of Schoo1 School District School Numbers Dates of enrollment Grades (city amp State)
---~~~
-~~~
~~~~~
middot ROE INDEPENDENT SCHOOL DISTRICT
(0 S Almiddotlt~L
This-free and reduced meal application is included in your Kindergarten packet to give you an opportunity to apply for free or reduced meals fell your student as heshe begins the 2014-15 school vea- at Conroe ISO By filling this out and submitting it our department can determine if yourrst~dent qualifies for the free or reduced lunch and if heshe qualifies can begin eating the
first day of schooL Please submit a new application next school year when you receive it because tltis application after approval is only good (or the first 30 days ofscltool Online applications are available and can be accessed through the Child Nutrition website We ENCOURAGE all families to apply on-line as this takes about twenty-Cour hours to process unless the student is not in the system yet The online application witl open the week of August 4h Parents can apply at wwwpplvforlunchcol11
Thank You Child Nutrition
Esta carta y la solicitud de comidas gratis 0 a precio reducido vienen dentro del paquete de inscripci6n al Jardin de Niflos (Kindergarten) para que usted pueda solicitar comidas gratis 0 a precio reducido para SlI estudiante durante el cicio escolar 2014-15 en Conroe ISD Una vez que usted entregue esta sol icitlld Ilena nuestro departamento podni determinar si SlI estudiante cllmple can los requisitos para recibir comidas gratis 0 a precio reducido En caso de que su
estudiante sea aprobado ellella podnl recibir com ida desde el primer dia de clases Nota Usted deberii lIenar V devolver una nueva solicitlld en cilanto la reciba al inicio del siguiente cicio escolar porque est primera solicitlld es temporal solamente sera valida dllrante los primeros 30 dias de clase (en ClISO de aber sido aprobada) Tambien podra lIenar la solicitud en linea Busquela en nllestra pagina electr6nica en el menLI PARENTS y luego en CHILD NUTRITION Invitamos a las familias a que tramitel1 su solicitud en lfnea debido a que este tnil11ite solamente dura 24 horas a menos que el estudiante no este dado de alta en el sistema La opci6n de presentar Ia solicitud en linea se abrira durante la semana del4 de agosto Los padres podran tramitar su solicitud en wwwapplyforlul1chcom
Atentamente Departamento de Nutrici6n Infantil
2015 -2016 1--middotmiddotFamilv Survev I Campus name Campus Conroe ISO -170902 L-I---------------- shy
N arne of child ---------------____-------shy
Grade level ---__ - Date
Dear Parents
In order to better serve your children the school district would like to identify students who may qualify to receive additional educational services The information provided below will be kept confidential Please answer the following questions and return this survey to your childs school
Please provide the following information (Only if yes was answered to questions 1 amp 2 above)
Name of child ____ _ ___ Age ___ Grade ___
Father Guardian ~__ __~__~__________________~_ _____________~
Mother Guardian _ _________
Street City State Zip
Home Telephone Number __ _____~
Other Phone _____ bull--- ------ ------- shy
The Conroe Independent Schoo District does not discriminate on the basis ot race color naUana origin sex disability or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups The followlng persons have been designated to handle inquiries regatdlng these non-discrimination pofiCies
l1na IX Coordinator 3205 W Davis COnroe Texas 77304 (936l-709~7700 and the Section 504ADA Coordinator 3205 W Oavis Conroe Texas 77304 (936) 709middot7670
Community Outreach and Dropout Prevention Rodrigo Chaves DirectorNROE
INDEPENDENT SCHOOL DISTRICT 3205 West Davis bull Conroe Texas 77304-2098 ~to-amp~ 9367097759
bull bull
Conroe Independent School District 2015-2016 Application for Free and Reduced Price School Meals Return to the school cafeteria manager or mail to the Conroe ISO Child Nutrition Department
bull Use black ink Print neatly Complete one application per household 3205 West Davis Conroe TX 77302-2098
~ List ALL household members who are infants children and students up to and including grade 12 (If more space is required for additional names attach another sheet ofpaper) Homeloss
Brthdate School roster migrant Legal first name MI Legal last name MM DO yy Grade Code Child runaway
Definition of Household Member Anyone who is living with you and shares income and expenses even if not related
Children in foster care and children who meet the definition of Homeless Migrant or Runaway are eligible for free meals Read How to Apply for Free and Reduced Price School Meals for more information
~ Do any Household Members (including you) currently participate in one or more of the following assistance programs SNAP TANF FDPIR Check the appropriate box below
If you did not check one of the boxes If you Checked one of the boxes to the left write EDG number here
SNAP TANF FDPIR to the leI conplete SECTION 3 then go to SECTiON 4 (Do Not complete SECTION 3) EDG number ~ Report income for ALL Household Members (skip this step if you answered yes to SECTION 2)
A Child Income Sometimes children in the household earn income Please indicate the TOTAL income earned by all Household Members in SECTION 1 here Child income
B All Adult Household Members (including yourself) List all Household Members not listed in SECTION 1 (including yourself) even if they did not receive income For each Household Member listed if they receive income report total income for each source in whole dollars ONLY If they Do Not receive income from any WET M source check the no income box If you check the no income box yu are certifying (promising) that there is no income to report
W = Weekly E Every two weeks T Twice per month M Monthly A = Annually Public Assistance
Name of Adult Household Member (first and last) Earnings from work Fill In circle Child SupporVAlimony Fill in circleI I Please read How to 81 Apply for Free and Reduced Price School Meals for more information The Sources of Income for Children section will help
lEC ryou wijh the Child Income questions The Sources of Income for Adults section will help you with EMJ the All Adult Household Members section
bull Write total number of Household Members here Last four digits of Social Security Number (SSN)
~ Contact Information and Adult Signature I certify (promise) that all infmation on this application is true and that all income is reported I understand that this information is given in connection with the receipt of Federal funds and that school officials may verify (check) the information I am aware that if I purposely give false information my children may lose meal benefits and I may be prosecuted under applicable State and Federal laws Street address Zip Daytime phone
~-~T-T---~r---~r------------------~ ~~--- i
bull Do not fill out this part For school use only Printed name of adult completing this form xsign here Todays date
Received Reviewing officials signature Date Confirming officials Signature _ Date FollOW-Up officials signature Date
~ --~~~~~~~------
Printed name ofstuqent
Signature ofstudent
Signature ofparent
~~ --~
Date
INDEPENDENT SCHOOL DISTRICT
~to-amp~
Nombre del alumno (tetra de molde)
FIrma del alumno
Finna del padre
Fecha
I unders+anc I wilt haJ~ to pick +hi~ Ll~ -frOYl the- -9r0nt office yo emendD qyc de-bo
de leC0cter eS+Gl COplCV d~ let ofc-incc prinCipal
Dear Pltlrent or Guardian
Throughout the year different orgmizations come to Creighton Elementary wanting to assist our shldents and families with school supplies clothing and other various needs The Family Educational Rights and privacy Act a federal law that make student educational records confidentiat prohibits us from releltlsing student information to these ltlgencies without your permission Tb help us work with these groups in the most efficient way possible we ask that if you are interested in such assistance you complete and sign the form below The form should be rehlmed to Susan Fossler
These assistance programs vary from year to year Giving us permission to release your information does not automatically mean vou will receive assistance It does let ~tS knmj that you would welcome such assistance and would be willing to have your information released to these orgaJ~izations In turn these groups agree to use your information only for the purpose of their assistance program(s) It is also required that your consent for release of information be updated annually If you have a question feel free to contact your childs counselor
Sincerely
Jenny Watson Principal
Shldent name Nomlm dd (studiallte _
Parents names Nombre dc padre 0 cllcl1Ixado __
AddressDirccci611
Phone Tcitfi)ffo
Are there siblings ~Ticllc hermallitos i_- yes sl no noJ
Estimado Padre de Familia 0 encargado
Durante el ano diferentes organizaciones vienen a la escuela Creighton Elementary con eJ objetivo de
ayudar a nuestros estudiantes y sus familia res con utiles escolares ropa y otras necesidades
El Acto de Privacidad y Derechos Educacionales de la Familia una ley federal que hace que los archivos e historial educativo del eshldiante sean confidenciales nos prohibe que divulguemos informacion de estudiantes a tales organizaciones sin e1
permiso suyo Para que nos ayude a trabajar y cooperltlr con esas organizaciones de la manera
mas eficiente Ie pedimos que si LIsted esta interesado (a) en recibir dicho tipo de asistencia 0
ayuda que complete y firme la forma abajo Esta forma la debe de regresar a Susan Fossler
Estos programas de asistencia varian de ano a ano El que nos autorice a dar el permiso pedido no signifiea que recibira ayuda automaticamente Lo que nos indica es que LJsted esta dispuesto (a) a recibir dicha asistencia y que acepta que la informacion suya sea compartida con esas organizaciones Esto pennite a que estos grupos y organizaciones acuerden usar dicha informacion soJamente para e1 prop6sito del program de asistencia Tambien se requiere que renueve este permiso de divulgaci6n de informacion anualmente Si tiene alguna pregunta contacte al consejero (a) de su hijo (a)
Sincerely
Jenny Watson Prillcipal
If yes names and ages of siblings I Nomnc y cdad de los hCrl11111 itos
Parent signature Firma del padre Date I Fecha
Name of student (Nombre del estudiante) _______________________
Address (Domicilio)
ID (Numero de identificaci6n) _~____ Grade (Grado) ___
This fonn should be filled in and signed by parent or guardian for pre-kindergarten-8 students or by the student in grades 9-12 (Este formulari 0 debe completarlo y firmarlo el padremadre 0 tutor legal de los estudiantes que cursan los grados de prekindergarten a octavo 0 por el estudiante en los gmdos superiores)
Refer to Chapter 89 1215
What language is spoken in your home most of the time ~Cual es el idioma que mas se habla en su
What language does your child speak most of the time ~Cual es el idioma que mas habla su hijoa _________________
What language does your child speak and understand best zQue idioma habla y entiende mejor su hijoa _________________
Has your child lived outside the United States for two or more consecutive years zHa vivido su hijoa fuera de los Estados Unidos por dos 0 mas anos consecutivos C Yes No
How long has your child lived in the United States iCwinto tiempo ha vivido su hijoa en los Estados Unidos _________________
Has your sondaughter changed school districts within the last three years LSe ha cambiado su hljoa de distrito escolar durante los ultimos tres aiios 0 Yes 0 No
Did your child attend school regularly in the United States or in hisher native country LAsisti6 su hijoa con regularidad ala escuela en los Estados Unidos 0 palS nativo D Yes 0 No
Yes my child attended school regularly in the United States or in my country of origin and finished the previous grade Si mi hijoa asisti6 con regularidad ala escuela en los Estados Unidos 0 en mi pais de origen y termin6 el grado inmediato anterior
o No my child did not attend school regularly in the United States or in my country of origin and did not finish the previous grade as stated below (Specify the grade month and year your child failed to attend school Do not include if absences were less than a month) No mi hijoa no asisti6 con regularidad a la escuela en los Estados Unidos ni en mi pais de origen yno termin6 el grado inmediato anterior segun se especifica (Especifique el grado mes y ano cuando S1-l hijoa no asisti6 a la escuela No incluya este dato si falt6 a la escuela menos de un mes)
__-__---shy---------~----
Signature of parent (Firma del o tutor legal)
CISDmiddot17 (9111) White copymiddot Cumulative Folder Yellow copymiddot Green Foldermiddot Pink copy AI-risk Counselor lCavh~t~OI~lonQ IVI_~~pl)oamprcI~XJIIrvt~ltrtt1lII_apy~J 81IJ1ltn-Irf~ptC9 UocUgtJI II-laquoJ~IIIlaquon ~mgtIlOYInD-eoJtrylliloVlTnoWiJCflylt~(J~o cdod
ToIXctIhooE~~d 15n a~~Ogtt~_d 1915 fndS ~d II_411mdlfrau-_ta ~n~ _~ aorlJdlytlor--shy
i[Mtf~~_c(prPflais ~IWP~__~_fOlpVN~~~~ c~VI~_~lIk1OatJltf__dillcJ~_~ovou_tJo~ltJo _ fJ~$If~~ _ IN~ IIOQIIQul_ffir_Yl rl__ W~kbodl~ClWn I64 f __bull rlMoalthgtliltspound~1L-u_ ~T_ ooIl4da~f_ 19 ~ soamp5()iltM~~ 191) _~_tu~ltUOO ~u_CltI~p
Texas Education Agency Texas Public School StudenUStaff Ethnicity and Race Data Questionnaire
The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting thedata for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity Is the person HispanicLatino (Choose only one)
D HispanicLatino - A person of Cuban Mexican Puerto Rican South or Central American or other Spanish culture or origin regardless of race
D Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more)
D American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America) and who maintains a tribal affiliation or community attachment
D Asian - A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Philippine Islands Thailand and Vietnam
D Black or African American - A person having origins in any of the black racial groups of Africa
o Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii Guam Samoa or other Pacific Islands
o White - A person having origins in any of the original peoples of Europe the Middle East or North Africa
StudentlStaff Name (please print) (ParentlG uardian)(Staff) Signature
StudentlStaff Identification Number Date
-----
-------
----
I
I
Conroe Independent School District (170902) Creighton Elementary School 106
Campus Namenumber
Students Legal Name Student ID
Please fill out the following information for all school in which this student was previously enrolled
Narne of Schoo1 School District School Numbers Dates of enrollment Grades (city amp State)
---~~~
-~~~
~~~~~
middot ROE INDEPENDENT SCHOOL DISTRICT
(0 S Almiddotlt~L
This-free and reduced meal application is included in your Kindergarten packet to give you an opportunity to apply for free or reduced meals fell your student as heshe begins the 2014-15 school vea- at Conroe ISO By filling this out and submitting it our department can determine if yourrst~dent qualifies for the free or reduced lunch and if heshe qualifies can begin eating the
first day of schooL Please submit a new application next school year when you receive it because tltis application after approval is only good (or the first 30 days ofscltool Online applications are available and can be accessed through the Child Nutrition website We ENCOURAGE all families to apply on-line as this takes about twenty-Cour hours to process unless the student is not in the system yet The online application witl open the week of August 4h Parents can apply at wwwpplvforlunchcol11
Thank You Child Nutrition
Esta carta y la solicitud de comidas gratis 0 a precio reducido vienen dentro del paquete de inscripci6n al Jardin de Niflos (Kindergarten) para que usted pueda solicitar comidas gratis 0 a precio reducido para SlI estudiante durante el cicio escolar 2014-15 en Conroe ISD Una vez que usted entregue esta sol icitlld Ilena nuestro departamento podni determinar si SlI estudiante cllmple can los requisitos para recibir comidas gratis 0 a precio reducido En caso de que su
estudiante sea aprobado ellella podnl recibir com ida desde el primer dia de clases Nota Usted deberii lIenar V devolver una nueva solicitlld en cilanto la reciba al inicio del siguiente cicio escolar porque est primera solicitlld es temporal solamente sera valida dllrante los primeros 30 dias de clase (en ClISO de aber sido aprobada) Tambien podra lIenar la solicitud en linea Busquela en nllestra pagina electr6nica en el menLI PARENTS y luego en CHILD NUTRITION Invitamos a las familias a que tramitel1 su solicitud en lfnea debido a que este tnil11ite solamente dura 24 horas a menos que el estudiante no este dado de alta en el sistema La opci6n de presentar Ia solicitud en linea se abrira durante la semana del4 de agosto Los padres podran tramitar su solicitud en wwwapplyforlul1chcom
Atentamente Departamento de Nutrici6n Infantil
2015 -2016 1--middotmiddotFamilv Survev I Campus name Campus Conroe ISO -170902 L-I---------------- shy
N arne of child ---------------____-------shy
Grade level ---__ - Date
Dear Parents
In order to better serve your children the school district would like to identify students who may qualify to receive additional educational services The information provided below will be kept confidential Please answer the following questions and return this survey to your childs school
Please provide the following information (Only if yes was answered to questions 1 amp 2 above)
Name of child ____ _ ___ Age ___ Grade ___
Father Guardian ~__ __~__~__________________~_ _____________~
Mother Guardian _ _________
Street City State Zip
Home Telephone Number __ _____~
Other Phone _____ bull--- ------ ------- shy
The Conroe Independent Schoo District does not discriminate on the basis ot race color naUana origin sex disability or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups The followlng persons have been designated to handle inquiries regatdlng these non-discrimination pofiCies
l1na IX Coordinator 3205 W Davis COnroe Texas 77304 (936l-709~7700 and the Section 504ADA Coordinator 3205 W Oavis Conroe Texas 77304 (936) 709middot7670
Community Outreach and Dropout Prevention Rodrigo Chaves DirectorNROE
INDEPENDENT SCHOOL DISTRICT 3205 West Davis bull Conroe Texas 77304-2098 ~to-amp~ 9367097759
bull bull
Conroe Independent School District 2015-2016 Application for Free and Reduced Price School Meals Return to the school cafeteria manager or mail to the Conroe ISO Child Nutrition Department
bull Use black ink Print neatly Complete one application per household 3205 West Davis Conroe TX 77302-2098
~ List ALL household members who are infants children and students up to and including grade 12 (If more space is required for additional names attach another sheet ofpaper) Homeloss
Brthdate School roster migrant Legal first name MI Legal last name MM DO yy Grade Code Child runaway
Definition of Household Member Anyone who is living with you and shares income and expenses even if not related
Children in foster care and children who meet the definition of Homeless Migrant or Runaway are eligible for free meals Read How to Apply for Free and Reduced Price School Meals for more information
~ Do any Household Members (including you) currently participate in one or more of the following assistance programs SNAP TANF FDPIR Check the appropriate box below
If you did not check one of the boxes If you Checked one of the boxes to the left write EDG number here
SNAP TANF FDPIR to the leI conplete SECTION 3 then go to SECTiON 4 (Do Not complete SECTION 3) EDG number ~ Report income for ALL Household Members (skip this step if you answered yes to SECTION 2)
A Child Income Sometimes children in the household earn income Please indicate the TOTAL income earned by all Household Members in SECTION 1 here Child income
B All Adult Household Members (including yourself) List all Household Members not listed in SECTION 1 (including yourself) even if they did not receive income For each Household Member listed if they receive income report total income for each source in whole dollars ONLY If they Do Not receive income from any WET M source check the no income box If you check the no income box yu are certifying (promising) that there is no income to report
W = Weekly E Every two weeks T Twice per month M Monthly A = Annually Public Assistance
Name of Adult Household Member (first and last) Earnings from work Fill In circle Child SupporVAlimony Fill in circleI I Please read How to 81 Apply for Free and Reduced Price School Meals for more information The Sources of Income for Children section will help
lEC ryou wijh the Child Income questions The Sources of Income for Adults section will help you with EMJ the All Adult Household Members section
bull Write total number of Household Members here Last four digits of Social Security Number (SSN)
~ Contact Information and Adult Signature I certify (promise) that all infmation on this application is true and that all income is reported I understand that this information is given in connection with the receipt of Federal funds and that school officials may verify (check) the information I am aware that if I purposely give false information my children may lose meal benefits and I may be prosecuted under applicable State and Federal laws Street address Zip Daytime phone
~-~T-T---~r---~r------------------~ ~~--- i
bull Do not fill out this part For school use only Printed name of adult completing this form xsign here Todays date
Received Reviewing officials signature Date Confirming officials Signature _ Date FollOW-Up officials signature Date
~ --~~~~~~~------
Printed name ofstuqent
Signature ofstudent
Signature ofparent
~~ --~
Date
INDEPENDENT SCHOOL DISTRICT
~to-amp~
Nombre del alumno (tetra de molde)
FIrma del alumno
Finna del padre
Fecha
I unders+anc I wilt haJ~ to pick +hi~ Ll~ -frOYl the- -9r0nt office yo emendD qyc de-bo
de leC0cter eS+Gl COplCV d~ let ofc-incc prinCipal
Dear Pltlrent or Guardian
Throughout the year different orgmizations come to Creighton Elementary wanting to assist our shldents and families with school supplies clothing and other various needs The Family Educational Rights and privacy Act a federal law that make student educational records confidentiat prohibits us from releltlsing student information to these ltlgencies without your permission Tb help us work with these groups in the most efficient way possible we ask that if you are interested in such assistance you complete and sign the form below The form should be rehlmed to Susan Fossler
These assistance programs vary from year to year Giving us permission to release your information does not automatically mean vou will receive assistance It does let ~tS knmj that you would welcome such assistance and would be willing to have your information released to these orgaJ~izations In turn these groups agree to use your information only for the purpose of their assistance program(s) It is also required that your consent for release of information be updated annually If you have a question feel free to contact your childs counselor
Sincerely
Jenny Watson Principal
Shldent name Nomlm dd (studiallte _
Parents names Nombre dc padre 0 cllcl1Ixado __
AddressDirccci611
Phone Tcitfi)ffo
Are there siblings ~Ticllc hermallitos i_- yes sl no noJ
Estimado Padre de Familia 0 encargado
Durante el ano diferentes organizaciones vienen a la escuela Creighton Elementary con eJ objetivo de
ayudar a nuestros estudiantes y sus familia res con utiles escolares ropa y otras necesidades
El Acto de Privacidad y Derechos Educacionales de la Familia una ley federal que hace que los archivos e historial educativo del eshldiante sean confidenciales nos prohibe que divulguemos informacion de estudiantes a tales organizaciones sin e1
permiso suyo Para que nos ayude a trabajar y cooperltlr con esas organizaciones de la manera
mas eficiente Ie pedimos que si LIsted esta interesado (a) en recibir dicho tipo de asistencia 0
ayuda que complete y firme la forma abajo Esta forma la debe de regresar a Susan Fossler
Estos programas de asistencia varian de ano a ano El que nos autorice a dar el permiso pedido no signifiea que recibira ayuda automaticamente Lo que nos indica es que LJsted esta dispuesto (a) a recibir dicha asistencia y que acepta que la informacion suya sea compartida con esas organizaciones Esto pennite a que estos grupos y organizaciones acuerden usar dicha informacion soJamente para e1 prop6sito del program de asistencia Tambien se requiere que renueve este permiso de divulgaci6n de informacion anualmente Si tiene alguna pregunta contacte al consejero (a) de su hijo (a)
Sincerely
Jenny Watson Prillcipal
If yes names and ages of siblings I Nomnc y cdad de los hCrl11111 itos
Parent signature Firma del padre Date I Fecha
Texas Education Agency Texas Public School StudenUStaff Ethnicity and Race Data Questionnaire
The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC)
School district staff and parents or guardians of students enrolling in school are requested to provide this information If you decline to provide this information please be aware that the USDE requires school districts to use observer identification as a last resort for collecting thedata for federal reporting
Please answer both parts of the following questions on the students or staff members ethnicity and race United States Federal Register (71 FR 44866)
Part 1 Ethnicity Is the person HispanicLatino (Choose only one)
D HispanicLatino - A person of Cuban Mexican Puerto Rican South or Central American or other Spanish culture or origin regardless of race
D Not HispanicLatino
Part 2 Race What is the persons race (Choose one or more)
D American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America) and who maintains a tribal affiliation or community attachment
D Asian - A person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Philippine Islands Thailand and Vietnam
D Black or African American - A person having origins in any of the black racial groups of Africa
o Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii Guam Samoa or other Pacific Islands
o White - A person having origins in any of the original peoples of Europe the Middle East or North Africa
StudentlStaff Name (please print) (ParentlG uardian)(Staff) Signature
StudentlStaff Identification Number Date
-----
-------
----
I
I
Conroe Independent School District (170902) Creighton Elementary School 106
Campus Namenumber
Students Legal Name Student ID
Please fill out the following information for all school in which this student was previously enrolled
Narne of Schoo1 School District School Numbers Dates of enrollment Grades (city amp State)
---~~~
-~~~
~~~~~
middot ROE INDEPENDENT SCHOOL DISTRICT
(0 S Almiddotlt~L
This-free and reduced meal application is included in your Kindergarten packet to give you an opportunity to apply for free or reduced meals fell your student as heshe begins the 2014-15 school vea- at Conroe ISO By filling this out and submitting it our department can determine if yourrst~dent qualifies for the free or reduced lunch and if heshe qualifies can begin eating the
first day of schooL Please submit a new application next school year when you receive it because tltis application after approval is only good (or the first 30 days ofscltool Online applications are available and can be accessed through the Child Nutrition website We ENCOURAGE all families to apply on-line as this takes about twenty-Cour hours to process unless the student is not in the system yet The online application witl open the week of August 4h Parents can apply at wwwpplvforlunchcol11
Thank You Child Nutrition
Esta carta y la solicitud de comidas gratis 0 a precio reducido vienen dentro del paquete de inscripci6n al Jardin de Niflos (Kindergarten) para que usted pueda solicitar comidas gratis 0 a precio reducido para SlI estudiante durante el cicio escolar 2014-15 en Conroe ISD Una vez que usted entregue esta sol icitlld Ilena nuestro departamento podni determinar si SlI estudiante cllmple can los requisitos para recibir comidas gratis 0 a precio reducido En caso de que su
estudiante sea aprobado ellella podnl recibir com ida desde el primer dia de clases Nota Usted deberii lIenar V devolver una nueva solicitlld en cilanto la reciba al inicio del siguiente cicio escolar porque est primera solicitlld es temporal solamente sera valida dllrante los primeros 30 dias de clase (en ClISO de aber sido aprobada) Tambien podra lIenar la solicitud en linea Busquela en nllestra pagina electr6nica en el menLI PARENTS y luego en CHILD NUTRITION Invitamos a las familias a que tramitel1 su solicitud en lfnea debido a que este tnil11ite solamente dura 24 horas a menos que el estudiante no este dado de alta en el sistema La opci6n de presentar Ia solicitud en linea se abrira durante la semana del4 de agosto Los padres podran tramitar su solicitud en wwwapplyforlul1chcom
Atentamente Departamento de Nutrici6n Infantil
2015 -2016 1--middotmiddotFamilv Survev I Campus name Campus Conroe ISO -170902 L-I---------------- shy
N arne of child ---------------____-------shy
Grade level ---__ - Date
Dear Parents
In order to better serve your children the school district would like to identify students who may qualify to receive additional educational services The information provided below will be kept confidential Please answer the following questions and return this survey to your childs school
Please provide the following information (Only if yes was answered to questions 1 amp 2 above)
Name of child ____ _ ___ Age ___ Grade ___
Father Guardian ~__ __~__~__________________~_ _____________~
Mother Guardian _ _________
Street City State Zip
Home Telephone Number __ _____~
Other Phone _____ bull--- ------ ------- shy
The Conroe Independent Schoo District does not discriminate on the basis ot race color naUana origin sex disability or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups The followlng persons have been designated to handle inquiries regatdlng these non-discrimination pofiCies
l1na IX Coordinator 3205 W Davis COnroe Texas 77304 (936l-709~7700 and the Section 504ADA Coordinator 3205 W Oavis Conroe Texas 77304 (936) 709middot7670
Community Outreach and Dropout Prevention Rodrigo Chaves DirectorNROE
INDEPENDENT SCHOOL DISTRICT 3205 West Davis bull Conroe Texas 77304-2098 ~to-amp~ 9367097759
bull bull
Conroe Independent School District 2015-2016 Application for Free and Reduced Price School Meals Return to the school cafeteria manager or mail to the Conroe ISO Child Nutrition Department
bull Use black ink Print neatly Complete one application per household 3205 West Davis Conroe TX 77302-2098
~ List ALL household members who are infants children and students up to and including grade 12 (If more space is required for additional names attach another sheet ofpaper) Homeloss
Brthdate School roster migrant Legal first name MI Legal last name MM DO yy Grade Code Child runaway
Definition of Household Member Anyone who is living with you and shares income and expenses even if not related
Children in foster care and children who meet the definition of Homeless Migrant or Runaway are eligible for free meals Read How to Apply for Free and Reduced Price School Meals for more information
~ Do any Household Members (including you) currently participate in one or more of the following assistance programs SNAP TANF FDPIR Check the appropriate box below
If you did not check one of the boxes If you Checked one of the boxes to the left write EDG number here
SNAP TANF FDPIR to the leI conplete SECTION 3 then go to SECTiON 4 (Do Not complete SECTION 3) EDG number ~ Report income for ALL Household Members (skip this step if you answered yes to SECTION 2)
A Child Income Sometimes children in the household earn income Please indicate the TOTAL income earned by all Household Members in SECTION 1 here Child income
B All Adult Household Members (including yourself) List all Household Members not listed in SECTION 1 (including yourself) even if they did not receive income For each Household Member listed if they receive income report total income for each source in whole dollars ONLY If they Do Not receive income from any WET M source check the no income box If you check the no income box yu are certifying (promising) that there is no income to report
W = Weekly E Every two weeks T Twice per month M Monthly A = Annually Public Assistance
Name of Adult Household Member (first and last) Earnings from work Fill In circle Child SupporVAlimony Fill in circleI I Please read How to 81 Apply for Free and Reduced Price School Meals for more information The Sources of Income for Children section will help
lEC ryou wijh the Child Income questions The Sources of Income for Adults section will help you with EMJ the All Adult Household Members section
bull Write total number of Household Members here Last four digits of Social Security Number (SSN)
~ Contact Information and Adult Signature I certify (promise) that all infmation on this application is true and that all income is reported I understand that this information is given in connection with the receipt of Federal funds and that school officials may verify (check) the information I am aware that if I purposely give false information my children may lose meal benefits and I may be prosecuted under applicable State and Federal laws Street address Zip Daytime phone
~-~T-T---~r---~r------------------~ ~~--- i
bull Do not fill out this part For school use only Printed name of adult completing this form xsign here Todays date
Received Reviewing officials signature Date Confirming officials Signature _ Date FollOW-Up officials signature Date
~ --~~~~~~~------
Printed name ofstuqent
Signature ofstudent
Signature ofparent
~~ --~
Date
INDEPENDENT SCHOOL DISTRICT
~to-amp~
Nombre del alumno (tetra de molde)
FIrma del alumno
Finna del padre
Fecha
I unders+anc I wilt haJ~ to pick +hi~ Ll~ -frOYl the- -9r0nt office yo emendD qyc de-bo
de leC0cter eS+Gl COplCV d~ let ofc-incc prinCipal
Dear Pltlrent or Guardian
Throughout the year different orgmizations come to Creighton Elementary wanting to assist our shldents and families with school supplies clothing and other various needs The Family Educational Rights and privacy Act a federal law that make student educational records confidentiat prohibits us from releltlsing student information to these ltlgencies without your permission Tb help us work with these groups in the most efficient way possible we ask that if you are interested in such assistance you complete and sign the form below The form should be rehlmed to Susan Fossler
These assistance programs vary from year to year Giving us permission to release your information does not automatically mean vou will receive assistance It does let ~tS knmj that you would welcome such assistance and would be willing to have your information released to these orgaJ~izations In turn these groups agree to use your information only for the purpose of their assistance program(s) It is also required that your consent for release of information be updated annually If you have a question feel free to contact your childs counselor
Sincerely
Jenny Watson Principal
Shldent name Nomlm dd (studiallte _
Parents names Nombre dc padre 0 cllcl1Ixado __
AddressDirccci611
Phone Tcitfi)ffo
Are there siblings ~Ticllc hermallitos i_- yes sl no noJ
Estimado Padre de Familia 0 encargado
Durante el ano diferentes organizaciones vienen a la escuela Creighton Elementary con eJ objetivo de
ayudar a nuestros estudiantes y sus familia res con utiles escolares ropa y otras necesidades
El Acto de Privacidad y Derechos Educacionales de la Familia una ley federal que hace que los archivos e historial educativo del eshldiante sean confidenciales nos prohibe que divulguemos informacion de estudiantes a tales organizaciones sin e1
permiso suyo Para que nos ayude a trabajar y cooperltlr con esas organizaciones de la manera
mas eficiente Ie pedimos que si LIsted esta interesado (a) en recibir dicho tipo de asistencia 0
ayuda que complete y firme la forma abajo Esta forma la debe de regresar a Susan Fossler
Estos programas de asistencia varian de ano a ano El que nos autorice a dar el permiso pedido no signifiea que recibira ayuda automaticamente Lo que nos indica es que LJsted esta dispuesto (a) a recibir dicha asistencia y que acepta que la informacion suya sea compartida con esas organizaciones Esto pennite a que estos grupos y organizaciones acuerden usar dicha informacion soJamente para e1 prop6sito del program de asistencia Tambien se requiere que renueve este permiso de divulgaci6n de informacion anualmente Si tiene alguna pregunta contacte al consejero (a) de su hijo (a)
Sincerely
Jenny Watson Prillcipal
If yes names and ages of siblings I Nomnc y cdad de los hCrl11111 itos
Parent signature Firma del padre Date I Fecha
-----
-------
----
I
I
Conroe Independent School District (170902) Creighton Elementary School 106
Campus Namenumber
Students Legal Name Student ID
Please fill out the following information for all school in which this student was previously enrolled
Narne of Schoo1 School District School Numbers Dates of enrollment Grades (city amp State)
---~~~
-~~~
~~~~~
middot ROE INDEPENDENT SCHOOL DISTRICT
(0 S Almiddotlt~L
This-free and reduced meal application is included in your Kindergarten packet to give you an opportunity to apply for free or reduced meals fell your student as heshe begins the 2014-15 school vea- at Conroe ISO By filling this out and submitting it our department can determine if yourrst~dent qualifies for the free or reduced lunch and if heshe qualifies can begin eating the
first day of schooL Please submit a new application next school year when you receive it because tltis application after approval is only good (or the first 30 days ofscltool Online applications are available and can be accessed through the Child Nutrition website We ENCOURAGE all families to apply on-line as this takes about twenty-Cour hours to process unless the student is not in the system yet The online application witl open the week of August 4h Parents can apply at wwwpplvforlunchcol11
Thank You Child Nutrition
Esta carta y la solicitud de comidas gratis 0 a precio reducido vienen dentro del paquete de inscripci6n al Jardin de Niflos (Kindergarten) para que usted pueda solicitar comidas gratis 0 a precio reducido para SlI estudiante durante el cicio escolar 2014-15 en Conroe ISD Una vez que usted entregue esta sol icitlld Ilena nuestro departamento podni determinar si SlI estudiante cllmple can los requisitos para recibir comidas gratis 0 a precio reducido En caso de que su
estudiante sea aprobado ellella podnl recibir com ida desde el primer dia de clases Nota Usted deberii lIenar V devolver una nueva solicitlld en cilanto la reciba al inicio del siguiente cicio escolar porque est primera solicitlld es temporal solamente sera valida dllrante los primeros 30 dias de clase (en ClISO de aber sido aprobada) Tambien podra lIenar la solicitud en linea Busquela en nllestra pagina electr6nica en el menLI PARENTS y luego en CHILD NUTRITION Invitamos a las familias a que tramitel1 su solicitud en lfnea debido a que este tnil11ite solamente dura 24 horas a menos que el estudiante no este dado de alta en el sistema La opci6n de presentar Ia solicitud en linea se abrira durante la semana del4 de agosto Los padres podran tramitar su solicitud en wwwapplyforlul1chcom
Atentamente Departamento de Nutrici6n Infantil
2015 -2016 1--middotmiddotFamilv Survev I Campus name Campus Conroe ISO -170902 L-I---------------- shy
N arne of child ---------------____-------shy
Grade level ---__ - Date
Dear Parents
In order to better serve your children the school district would like to identify students who may qualify to receive additional educational services The information provided below will be kept confidential Please answer the following questions and return this survey to your childs school
Please provide the following information (Only if yes was answered to questions 1 amp 2 above)
Name of child ____ _ ___ Age ___ Grade ___
Father Guardian ~__ __~__~__________________~_ _____________~
Mother Guardian _ _________
Street City State Zip
Home Telephone Number __ _____~
Other Phone _____ bull--- ------ ------- shy
The Conroe Independent Schoo District does not discriminate on the basis ot race color naUana origin sex disability or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups The followlng persons have been designated to handle inquiries regatdlng these non-discrimination pofiCies
l1na IX Coordinator 3205 W Davis COnroe Texas 77304 (936l-709~7700 and the Section 504ADA Coordinator 3205 W Oavis Conroe Texas 77304 (936) 709middot7670
Community Outreach and Dropout Prevention Rodrigo Chaves DirectorNROE
INDEPENDENT SCHOOL DISTRICT 3205 West Davis bull Conroe Texas 77304-2098 ~to-amp~ 9367097759
bull bull
Conroe Independent School District 2015-2016 Application for Free and Reduced Price School Meals Return to the school cafeteria manager or mail to the Conroe ISO Child Nutrition Department
bull Use black ink Print neatly Complete one application per household 3205 West Davis Conroe TX 77302-2098
~ List ALL household members who are infants children and students up to and including grade 12 (If more space is required for additional names attach another sheet ofpaper) Homeloss
Brthdate School roster migrant Legal first name MI Legal last name MM DO yy Grade Code Child runaway
Definition of Household Member Anyone who is living with you and shares income and expenses even if not related
Children in foster care and children who meet the definition of Homeless Migrant or Runaway are eligible for free meals Read How to Apply for Free and Reduced Price School Meals for more information
~ Do any Household Members (including you) currently participate in one or more of the following assistance programs SNAP TANF FDPIR Check the appropriate box below
If you did not check one of the boxes If you Checked one of the boxes to the left write EDG number here
SNAP TANF FDPIR to the leI conplete SECTION 3 then go to SECTiON 4 (Do Not complete SECTION 3) EDG number ~ Report income for ALL Household Members (skip this step if you answered yes to SECTION 2)
A Child Income Sometimes children in the household earn income Please indicate the TOTAL income earned by all Household Members in SECTION 1 here Child income
B All Adult Household Members (including yourself) List all Household Members not listed in SECTION 1 (including yourself) even if they did not receive income For each Household Member listed if they receive income report total income for each source in whole dollars ONLY If they Do Not receive income from any WET M source check the no income box If you check the no income box yu are certifying (promising) that there is no income to report
W = Weekly E Every two weeks T Twice per month M Monthly A = Annually Public Assistance
Name of Adult Household Member (first and last) Earnings from work Fill In circle Child SupporVAlimony Fill in circleI I Please read How to 81 Apply for Free and Reduced Price School Meals for more information The Sources of Income for Children section will help
lEC ryou wijh the Child Income questions The Sources of Income for Adults section will help you with EMJ the All Adult Household Members section
bull Write total number of Household Members here Last four digits of Social Security Number (SSN)
~ Contact Information and Adult Signature I certify (promise) that all infmation on this application is true and that all income is reported I understand that this information is given in connection with the receipt of Federal funds and that school officials may verify (check) the information I am aware that if I purposely give false information my children may lose meal benefits and I may be prosecuted under applicable State and Federal laws Street address Zip Daytime phone
~-~T-T---~r---~r------------------~ ~~--- i
bull Do not fill out this part For school use only Printed name of adult completing this form xsign here Todays date
Received Reviewing officials signature Date Confirming officials Signature _ Date FollOW-Up officials signature Date
~ --~~~~~~~------
Printed name ofstuqent
Signature ofstudent
Signature ofparent
~~ --~
Date
INDEPENDENT SCHOOL DISTRICT
~to-amp~
Nombre del alumno (tetra de molde)
FIrma del alumno
Finna del padre
Fecha
I unders+anc I wilt haJ~ to pick +hi~ Ll~ -frOYl the- -9r0nt office yo emendD qyc de-bo
de leC0cter eS+Gl COplCV d~ let ofc-incc prinCipal
Dear Pltlrent or Guardian
Throughout the year different orgmizations come to Creighton Elementary wanting to assist our shldents and families with school supplies clothing and other various needs The Family Educational Rights and privacy Act a federal law that make student educational records confidentiat prohibits us from releltlsing student information to these ltlgencies without your permission Tb help us work with these groups in the most efficient way possible we ask that if you are interested in such assistance you complete and sign the form below The form should be rehlmed to Susan Fossler
These assistance programs vary from year to year Giving us permission to release your information does not automatically mean vou will receive assistance It does let ~tS knmj that you would welcome such assistance and would be willing to have your information released to these orgaJ~izations In turn these groups agree to use your information only for the purpose of their assistance program(s) It is also required that your consent for release of information be updated annually If you have a question feel free to contact your childs counselor
Sincerely
Jenny Watson Principal
Shldent name Nomlm dd (studiallte _
Parents names Nombre dc padre 0 cllcl1Ixado __
AddressDirccci611
Phone Tcitfi)ffo
Are there siblings ~Ticllc hermallitos i_- yes sl no noJ
Estimado Padre de Familia 0 encargado
Durante el ano diferentes organizaciones vienen a la escuela Creighton Elementary con eJ objetivo de
ayudar a nuestros estudiantes y sus familia res con utiles escolares ropa y otras necesidades
El Acto de Privacidad y Derechos Educacionales de la Familia una ley federal que hace que los archivos e historial educativo del eshldiante sean confidenciales nos prohibe que divulguemos informacion de estudiantes a tales organizaciones sin e1
permiso suyo Para que nos ayude a trabajar y cooperltlr con esas organizaciones de la manera
mas eficiente Ie pedimos que si LIsted esta interesado (a) en recibir dicho tipo de asistencia 0
ayuda que complete y firme la forma abajo Esta forma la debe de regresar a Susan Fossler
Estos programas de asistencia varian de ano a ano El que nos autorice a dar el permiso pedido no signifiea que recibira ayuda automaticamente Lo que nos indica es que LJsted esta dispuesto (a) a recibir dicha asistencia y que acepta que la informacion suya sea compartida con esas organizaciones Esto pennite a que estos grupos y organizaciones acuerden usar dicha informacion soJamente para e1 prop6sito del program de asistencia Tambien se requiere que renueve este permiso de divulgaci6n de informacion anualmente Si tiene alguna pregunta contacte al consejero (a) de su hijo (a)
Sincerely
Jenny Watson Prillcipal
If yes names and ages of siblings I Nomnc y cdad de los hCrl11111 itos
Parent signature Firma del padre Date I Fecha
middot ROE INDEPENDENT SCHOOL DISTRICT
(0 S Almiddotlt~L
This-free and reduced meal application is included in your Kindergarten packet to give you an opportunity to apply for free or reduced meals fell your student as heshe begins the 2014-15 school vea- at Conroe ISO By filling this out and submitting it our department can determine if yourrst~dent qualifies for the free or reduced lunch and if heshe qualifies can begin eating the
first day of schooL Please submit a new application next school year when you receive it because tltis application after approval is only good (or the first 30 days ofscltool Online applications are available and can be accessed through the Child Nutrition website We ENCOURAGE all families to apply on-line as this takes about twenty-Cour hours to process unless the student is not in the system yet The online application witl open the week of August 4h Parents can apply at wwwpplvforlunchcol11
Thank You Child Nutrition
Esta carta y la solicitud de comidas gratis 0 a precio reducido vienen dentro del paquete de inscripci6n al Jardin de Niflos (Kindergarten) para que usted pueda solicitar comidas gratis 0 a precio reducido para SlI estudiante durante el cicio escolar 2014-15 en Conroe ISD Una vez que usted entregue esta sol icitlld Ilena nuestro departamento podni determinar si SlI estudiante cllmple can los requisitos para recibir comidas gratis 0 a precio reducido En caso de que su
estudiante sea aprobado ellella podnl recibir com ida desde el primer dia de clases Nota Usted deberii lIenar V devolver una nueva solicitlld en cilanto la reciba al inicio del siguiente cicio escolar porque est primera solicitlld es temporal solamente sera valida dllrante los primeros 30 dias de clase (en ClISO de aber sido aprobada) Tambien podra lIenar la solicitud en linea Busquela en nllestra pagina electr6nica en el menLI PARENTS y luego en CHILD NUTRITION Invitamos a las familias a que tramitel1 su solicitud en lfnea debido a que este tnil11ite solamente dura 24 horas a menos que el estudiante no este dado de alta en el sistema La opci6n de presentar Ia solicitud en linea se abrira durante la semana del4 de agosto Los padres podran tramitar su solicitud en wwwapplyforlul1chcom
Atentamente Departamento de Nutrici6n Infantil
2015 -2016 1--middotmiddotFamilv Survev I Campus name Campus Conroe ISO -170902 L-I---------------- shy
N arne of child ---------------____-------shy
Grade level ---__ - Date
Dear Parents
In order to better serve your children the school district would like to identify students who may qualify to receive additional educational services The information provided below will be kept confidential Please answer the following questions and return this survey to your childs school
Please provide the following information (Only if yes was answered to questions 1 amp 2 above)
Name of child ____ _ ___ Age ___ Grade ___
Father Guardian ~__ __~__~__________________~_ _____________~
Mother Guardian _ _________
Street City State Zip
Home Telephone Number __ _____~
Other Phone _____ bull--- ------ ------- shy
The Conroe Independent Schoo District does not discriminate on the basis ot race color naUana origin sex disability or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups The followlng persons have been designated to handle inquiries regatdlng these non-discrimination pofiCies
l1na IX Coordinator 3205 W Davis COnroe Texas 77304 (936l-709~7700 and the Section 504ADA Coordinator 3205 W Oavis Conroe Texas 77304 (936) 709middot7670
Community Outreach and Dropout Prevention Rodrigo Chaves DirectorNROE
INDEPENDENT SCHOOL DISTRICT 3205 West Davis bull Conroe Texas 77304-2098 ~to-amp~ 9367097759
bull bull
Conroe Independent School District 2015-2016 Application for Free and Reduced Price School Meals Return to the school cafeteria manager or mail to the Conroe ISO Child Nutrition Department
bull Use black ink Print neatly Complete one application per household 3205 West Davis Conroe TX 77302-2098
~ List ALL household members who are infants children and students up to and including grade 12 (If more space is required for additional names attach another sheet ofpaper) Homeloss
Brthdate School roster migrant Legal first name MI Legal last name MM DO yy Grade Code Child runaway
Definition of Household Member Anyone who is living with you and shares income and expenses even if not related
Children in foster care and children who meet the definition of Homeless Migrant or Runaway are eligible for free meals Read How to Apply for Free and Reduced Price School Meals for more information
~ Do any Household Members (including you) currently participate in one or more of the following assistance programs SNAP TANF FDPIR Check the appropriate box below
If you did not check one of the boxes If you Checked one of the boxes to the left write EDG number here
SNAP TANF FDPIR to the leI conplete SECTION 3 then go to SECTiON 4 (Do Not complete SECTION 3) EDG number ~ Report income for ALL Household Members (skip this step if you answered yes to SECTION 2)
A Child Income Sometimes children in the household earn income Please indicate the TOTAL income earned by all Household Members in SECTION 1 here Child income
B All Adult Household Members (including yourself) List all Household Members not listed in SECTION 1 (including yourself) even if they did not receive income For each Household Member listed if they receive income report total income for each source in whole dollars ONLY If they Do Not receive income from any WET M source check the no income box If you check the no income box yu are certifying (promising) that there is no income to report
W = Weekly E Every two weeks T Twice per month M Monthly A = Annually Public Assistance
Name of Adult Household Member (first and last) Earnings from work Fill In circle Child SupporVAlimony Fill in circleI I Please read How to 81 Apply for Free and Reduced Price School Meals for more information The Sources of Income for Children section will help
lEC ryou wijh the Child Income questions The Sources of Income for Adults section will help you with EMJ the All Adult Household Members section
bull Write total number of Household Members here Last four digits of Social Security Number (SSN)
~ Contact Information and Adult Signature I certify (promise) that all infmation on this application is true and that all income is reported I understand that this information is given in connection with the receipt of Federal funds and that school officials may verify (check) the information I am aware that if I purposely give false information my children may lose meal benefits and I may be prosecuted under applicable State and Federal laws Street address Zip Daytime phone
~-~T-T---~r---~r------------------~ ~~--- i
bull Do not fill out this part For school use only Printed name of adult completing this form xsign here Todays date
Received Reviewing officials signature Date Confirming officials Signature _ Date FollOW-Up officials signature Date
~ --~~~~~~~------
Printed name ofstuqent
Signature ofstudent
Signature ofparent
~~ --~
Date
INDEPENDENT SCHOOL DISTRICT
~to-amp~
Nombre del alumno (tetra de molde)
FIrma del alumno
Finna del padre
Fecha
I unders+anc I wilt haJ~ to pick +hi~ Ll~ -frOYl the- -9r0nt office yo emendD qyc de-bo
de leC0cter eS+Gl COplCV d~ let ofc-incc prinCipal
Dear Pltlrent or Guardian
Throughout the year different orgmizations come to Creighton Elementary wanting to assist our shldents and families with school supplies clothing and other various needs The Family Educational Rights and privacy Act a federal law that make student educational records confidentiat prohibits us from releltlsing student information to these ltlgencies without your permission Tb help us work with these groups in the most efficient way possible we ask that if you are interested in such assistance you complete and sign the form below The form should be rehlmed to Susan Fossler
These assistance programs vary from year to year Giving us permission to release your information does not automatically mean vou will receive assistance It does let ~tS knmj that you would welcome such assistance and would be willing to have your information released to these orgaJ~izations In turn these groups agree to use your information only for the purpose of their assistance program(s) It is also required that your consent for release of information be updated annually If you have a question feel free to contact your childs counselor
Sincerely
Jenny Watson Principal
Shldent name Nomlm dd (studiallte _
Parents names Nombre dc padre 0 cllcl1Ixado __
AddressDirccci611
Phone Tcitfi)ffo
Are there siblings ~Ticllc hermallitos i_- yes sl no noJ
Estimado Padre de Familia 0 encargado
Durante el ano diferentes organizaciones vienen a la escuela Creighton Elementary con eJ objetivo de
ayudar a nuestros estudiantes y sus familia res con utiles escolares ropa y otras necesidades
El Acto de Privacidad y Derechos Educacionales de la Familia una ley federal que hace que los archivos e historial educativo del eshldiante sean confidenciales nos prohibe que divulguemos informacion de estudiantes a tales organizaciones sin e1
permiso suyo Para que nos ayude a trabajar y cooperltlr con esas organizaciones de la manera
mas eficiente Ie pedimos que si LIsted esta interesado (a) en recibir dicho tipo de asistencia 0
ayuda que complete y firme la forma abajo Esta forma la debe de regresar a Susan Fossler
Estos programas de asistencia varian de ano a ano El que nos autorice a dar el permiso pedido no signifiea que recibira ayuda automaticamente Lo que nos indica es que LJsted esta dispuesto (a) a recibir dicha asistencia y que acepta que la informacion suya sea compartida con esas organizaciones Esto pennite a que estos grupos y organizaciones acuerden usar dicha informacion soJamente para e1 prop6sito del program de asistencia Tambien se requiere que renueve este permiso de divulgaci6n de informacion anualmente Si tiene alguna pregunta contacte al consejero (a) de su hijo (a)
Sincerely
Jenny Watson Prillcipal
If yes names and ages of siblings I Nomnc y cdad de los hCrl11111 itos
Parent signature Firma del padre Date I Fecha
2015 -2016 1--middotmiddotFamilv Survev I Campus name Campus Conroe ISO -170902 L-I---------------- shy
N arne of child ---------------____-------shy
Grade level ---__ - Date
Dear Parents
In order to better serve your children the school district would like to identify students who may qualify to receive additional educational services The information provided below will be kept confidential Please answer the following questions and return this survey to your childs school
Please provide the following information (Only if yes was answered to questions 1 amp 2 above)
Name of child ____ _ ___ Age ___ Grade ___
Father Guardian ~__ __~__~__________________~_ _____________~
Mother Guardian _ _________
Street City State Zip
Home Telephone Number __ _____~
Other Phone _____ bull--- ------ ------- shy
The Conroe Independent Schoo District does not discriminate on the basis ot race color naUana origin sex disability or age in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups The followlng persons have been designated to handle inquiries regatdlng these non-discrimination pofiCies
l1na IX Coordinator 3205 W Davis COnroe Texas 77304 (936l-709~7700 and the Section 504ADA Coordinator 3205 W Oavis Conroe Texas 77304 (936) 709middot7670
Community Outreach and Dropout Prevention Rodrigo Chaves DirectorNROE
INDEPENDENT SCHOOL DISTRICT 3205 West Davis bull Conroe Texas 77304-2098 ~to-amp~ 9367097759
bull bull
Conroe Independent School District 2015-2016 Application for Free and Reduced Price School Meals Return to the school cafeteria manager or mail to the Conroe ISO Child Nutrition Department
bull Use black ink Print neatly Complete one application per household 3205 West Davis Conroe TX 77302-2098
~ List ALL household members who are infants children and students up to and including grade 12 (If more space is required for additional names attach another sheet ofpaper) Homeloss
Brthdate School roster migrant Legal first name MI Legal last name MM DO yy Grade Code Child runaway
Definition of Household Member Anyone who is living with you and shares income and expenses even if not related
Children in foster care and children who meet the definition of Homeless Migrant or Runaway are eligible for free meals Read How to Apply for Free and Reduced Price School Meals for more information
~ Do any Household Members (including you) currently participate in one or more of the following assistance programs SNAP TANF FDPIR Check the appropriate box below
If you did not check one of the boxes If you Checked one of the boxes to the left write EDG number here
SNAP TANF FDPIR to the leI conplete SECTION 3 then go to SECTiON 4 (Do Not complete SECTION 3) EDG number ~ Report income for ALL Household Members (skip this step if you answered yes to SECTION 2)
A Child Income Sometimes children in the household earn income Please indicate the TOTAL income earned by all Household Members in SECTION 1 here Child income
B All Adult Household Members (including yourself) List all Household Members not listed in SECTION 1 (including yourself) even if they did not receive income For each Household Member listed if they receive income report total income for each source in whole dollars ONLY If they Do Not receive income from any WET M source check the no income box If you check the no income box yu are certifying (promising) that there is no income to report
W = Weekly E Every two weeks T Twice per month M Monthly A = Annually Public Assistance
Name of Adult Household Member (first and last) Earnings from work Fill In circle Child SupporVAlimony Fill in circleI I Please read How to 81 Apply for Free and Reduced Price School Meals for more information The Sources of Income for Children section will help
lEC ryou wijh the Child Income questions The Sources of Income for Adults section will help you with EMJ the All Adult Household Members section
bull Write total number of Household Members here Last four digits of Social Security Number (SSN)
~ Contact Information and Adult Signature I certify (promise) that all infmation on this application is true and that all income is reported I understand that this information is given in connection with the receipt of Federal funds and that school officials may verify (check) the information I am aware that if I purposely give false information my children may lose meal benefits and I may be prosecuted under applicable State and Federal laws Street address Zip Daytime phone
~-~T-T---~r---~r------------------~ ~~--- i
bull Do not fill out this part For school use only Printed name of adult completing this form xsign here Todays date
Received Reviewing officials signature Date Confirming officials Signature _ Date FollOW-Up officials signature Date
~ --~~~~~~~------
Printed name ofstuqent
Signature ofstudent
Signature ofparent
~~ --~
Date
INDEPENDENT SCHOOL DISTRICT
~to-amp~
Nombre del alumno (tetra de molde)
FIrma del alumno
Finna del padre
Fecha
I unders+anc I wilt haJ~ to pick +hi~ Ll~ -frOYl the- -9r0nt office yo emendD qyc de-bo
de leC0cter eS+Gl COplCV d~ let ofc-incc prinCipal
Dear Pltlrent or Guardian
Throughout the year different orgmizations come to Creighton Elementary wanting to assist our shldents and families with school supplies clothing and other various needs The Family Educational Rights and privacy Act a federal law that make student educational records confidentiat prohibits us from releltlsing student information to these ltlgencies without your permission Tb help us work with these groups in the most efficient way possible we ask that if you are interested in such assistance you complete and sign the form below The form should be rehlmed to Susan Fossler
These assistance programs vary from year to year Giving us permission to release your information does not automatically mean vou will receive assistance It does let ~tS knmj that you would welcome such assistance and would be willing to have your information released to these orgaJ~izations In turn these groups agree to use your information only for the purpose of their assistance program(s) It is also required that your consent for release of information be updated annually If you have a question feel free to contact your childs counselor
Sincerely
Jenny Watson Principal
Shldent name Nomlm dd (studiallte _
Parents names Nombre dc padre 0 cllcl1Ixado __
AddressDirccci611
Phone Tcitfi)ffo
Are there siblings ~Ticllc hermallitos i_- yes sl no noJ
Estimado Padre de Familia 0 encargado
Durante el ano diferentes organizaciones vienen a la escuela Creighton Elementary con eJ objetivo de
ayudar a nuestros estudiantes y sus familia res con utiles escolares ropa y otras necesidades
El Acto de Privacidad y Derechos Educacionales de la Familia una ley federal que hace que los archivos e historial educativo del eshldiante sean confidenciales nos prohibe que divulguemos informacion de estudiantes a tales organizaciones sin e1
permiso suyo Para que nos ayude a trabajar y cooperltlr con esas organizaciones de la manera
mas eficiente Ie pedimos que si LIsted esta interesado (a) en recibir dicho tipo de asistencia 0
ayuda que complete y firme la forma abajo Esta forma la debe de regresar a Susan Fossler
Estos programas de asistencia varian de ano a ano El que nos autorice a dar el permiso pedido no signifiea que recibira ayuda automaticamente Lo que nos indica es que LJsted esta dispuesto (a) a recibir dicha asistencia y que acepta que la informacion suya sea compartida con esas organizaciones Esto pennite a que estos grupos y organizaciones acuerden usar dicha informacion soJamente para e1 prop6sito del program de asistencia Tambien se requiere que renueve este permiso de divulgaci6n de informacion anualmente Si tiene alguna pregunta contacte al consejero (a) de su hijo (a)
Sincerely
Jenny Watson Prillcipal
If yes names and ages of siblings I Nomnc y cdad de los hCrl11111 itos
Parent signature Firma del padre Date I Fecha
bull bull
Conroe Independent School District 2015-2016 Application for Free and Reduced Price School Meals Return to the school cafeteria manager or mail to the Conroe ISO Child Nutrition Department
bull Use black ink Print neatly Complete one application per household 3205 West Davis Conroe TX 77302-2098
~ List ALL household members who are infants children and students up to and including grade 12 (If more space is required for additional names attach another sheet ofpaper) Homeloss
Brthdate School roster migrant Legal first name MI Legal last name MM DO yy Grade Code Child runaway
Definition of Household Member Anyone who is living with you and shares income and expenses even if not related
Children in foster care and children who meet the definition of Homeless Migrant or Runaway are eligible for free meals Read How to Apply for Free and Reduced Price School Meals for more information
~ Do any Household Members (including you) currently participate in one or more of the following assistance programs SNAP TANF FDPIR Check the appropriate box below
If you did not check one of the boxes If you Checked one of the boxes to the left write EDG number here
SNAP TANF FDPIR to the leI conplete SECTION 3 then go to SECTiON 4 (Do Not complete SECTION 3) EDG number ~ Report income for ALL Household Members (skip this step if you answered yes to SECTION 2)
A Child Income Sometimes children in the household earn income Please indicate the TOTAL income earned by all Household Members in SECTION 1 here Child income
B All Adult Household Members (including yourself) List all Household Members not listed in SECTION 1 (including yourself) even if they did not receive income For each Household Member listed if they receive income report total income for each source in whole dollars ONLY If they Do Not receive income from any WET M source check the no income box If you check the no income box yu are certifying (promising) that there is no income to report
W = Weekly E Every two weeks T Twice per month M Monthly A = Annually Public Assistance
Name of Adult Household Member (first and last) Earnings from work Fill In circle Child SupporVAlimony Fill in circleI I Please read How to 81 Apply for Free and Reduced Price School Meals for more information The Sources of Income for Children section will help
lEC ryou wijh the Child Income questions The Sources of Income for Adults section will help you with EMJ the All Adult Household Members section
bull Write total number of Household Members here Last four digits of Social Security Number (SSN)
~ Contact Information and Adult Signature I certify (promise) that all infmation on this application is true and that all income is reported I understand that this information is given in connection with the receipt of Federal funds and that school officials may verify (check) the information I am aware that if I purposely give false information my children may lose meal benefits and I may be prosecuted under applicable State and Federal laws Street address Zip Daytime phone
~-~T-T---~r---~r------------------~ ~~--- i
bull Do not fill out this part For school use only Printed name of adult completing this form xsign here Todays date
Received Reviewing officials signature Date Confirming officials Signature _ Date FollOW-Up officials signature Date
~ --~~~~~~~------
Printed name ofstuqent
Signature ofstudent
Signature ofparent
~~ --~
Date
INDEPENDENT SCHOOL DISTRICT
~to-amp~
Nombre del alumno (tetra de molde)
FIrma del alumno
Finna del padre
Fecha
I unders+anc I wilt haJ~ to pick +hi~ Ll~ -frOYl the- -9r0nt office yo emendD qyc de-bo
de leC0cter eS+Gl COplCV d~ let ofc-incc prinCipal
Dear Pltlrent or Guardian
Throughout the year different orgmizations come to Creighton Elementary wanting to assist our shldents and families with school supplies clothing and other various needs The Family Educational Rights and privacy Act a federal law that make student educational records confidentiat prohibits us from releltlsing student information to these ltlgencies without your permission Tb help us work with these groups in the most efficient way possible we ask that if you are interested in such assistance you complete and sign the form below The form should be rehlmed to Susan Fossler
These assistance programs vary from year to year Giving us permission to release your information does not automatically mean vou will receive assistance It does let ~tS knmj that you would welcome such assistance and would be willing to have your information released to these orgaJ~izations In turn these groups agree to use your information only for the purpose of their assistance program(s) It is also required that your consent for release of information be updated annually If you have a question feel free to contact your childs counselor
Sincerely
Jenny Watson Principal
Shldent name Nomlm dd (studiallte _
Parents names Nombre dc padre 0 cllcl1Ixado __
AddressDirccci611
Phone Tcitfi)ffo
Are there siblings ~Ticllc hermallitos i_- yes sl no noJ
Estimado Padre de Familia 0 encargado
Durante el ano diferentes organizaciones vienen a la escuela Creighton Elementary con eJ objetivo de
ayudar a nuestros estudiantes y sus familia res con utiles escolares ropa y otras necesidades
El Acto de Privacidad y Derechos Educacionales de la Familia una ley federal que hace que los archivos e historial educativo del eshldiante sean confidenciales nos prohibe que divulguemos informacion de estudiantes a tales organizaciones sin e1
permiso suyo Para que nos ayude a trabajar y cooperltlr con esas organizaciones de la manera
mas eficiente Ie pedimos que si LIsted esta interesado (a) en recibir dicho tipo de asistencia 0
ayuda que complete y firme la forma abajo Esta forma la debe de regresar a Susan Fossler
Estos programas de asistencia varian de ano a ano El que nos autorice a dar el permiso pedido no signifiea que recibira ayuda automaticamente Lo que nos indica es que LJsted esta dispuesto (a) a recibir dicha asistencia y que acepta que la informacion suya sea compartida con esas organizaciones Esto pennite a que estos grupos y organizaciones acuerden usar dicha informacion soJamente para e1 prop6sito del program de asistencia Tambien se requiere que renueve este permiso de divulgaci6n de informacion anualmente Si tiene alguna pregunta contacte al consejero (a) de su hijo (a)
Sincerely
Jenny Watson Prillcipal
If yes names and ages of siblings I Nomnc y cdad de los hCrl11111 itos
Parent signature Firma del padre Date I Fecha
~ --~~~~~~~------
Printed name ofstuqent
Signature ofstudent
Signature ofparent
~~ --~
Date
INDEPENDENT SCHOOL DISTRICT
~to-amp~
Nombre del alumno (tetra de molde)
FIrma del alumno
Finna del padre
Fecha
I unders+anc I wilt haJ~ to pick +hi~ Ll~ -frOYl the- -9r0nt office yo emendD qyc de-bo
de leC0cter eS+Gl COplCV d~ let ofc-incc prinCipal
Dear Pltlrent or Guardian
Throughout the year different orgmizations come to Creighton Elementary wanting to assist our shldents and families with school supplies clothing and other various needs The Family Educational Rights and privacy Act a federal law that make student educational records confidentiat prohibits us from releltlsing student information to these ltlgencies without your permission Tb help us work with these groups in the most efficient way possible we ask that if you are interested in such assistance you complete and sign the form below The form should be rehlmed to Susan Fossler
These assistance programs vary from year to year Giving us permission to release your information does not automatically mean vou will receive assistance It does let ~tS knmj that you would welcome such assistance and would be willing to have your information released to these orgaJ~izations In turn these groups agree to use your information only for the purpose of their assistance program(s) It is also required that your consent for release of information be updated annually If you have a question feel free to contact your childs counselor
Sincerely
Jenny Watson Principal
Shldent name Nomlm dd (studiallte _
Parents names Nombre dc padre 0 cllcl1Ixado __
AddressDirccci611
Phone Tcitfi)ffo
Are there siblings ~Ticllc hermallitos i_- yes sl no noJ
Estimado Padre de Familia 0 encargado
Durante el ano diferentes organizaciones vienen a la escuela Creighton Elementary con eJ objetivo de
ayudar a nuestros estudiantes y sus familia res con utiles escolares ropa y otras necesidades
El Acto de Privacidad y Derechos Educacionales de la Familia una ley federal que hace que los archivos e historial educativo del eshldiante sean confidenciales nos prohibe que divulguemos informacion de estudiantes a tales organizaciones sin e1
permiso suyo Para que nos ayude a trabajar y cooperltlr con esas organizaciones de la manera
mas eficiente Ie pedimos que si LIsted esta interesado (a) en recibir dicho tipo de asistencia 0
ayuda que complete y firme la forma abajo Esta forma la debe de regresar a Susan Fossler
Estos programas de asistencia varian de ano a ano El que nos autorice a dar el permiso pedido no signifiea que recibira ayuda automaticamente Lo que nos indica es que LJsted esta dispuesto (a) a recibir dicha asistencia y que acepta que la informacion suya sea compartida con esas organizaciones Esto pennite a que estos grupos y organizaciones acuerden usar dicha informacion soJamente para e1 prop6sito del program de asistencia Tambien se requiere que renueve este permiso de divulgaci6n de informacion anualmente Si tiene alguna pregunta contacte al consejero (a) de su hijo (a)
Sincerely
Jenny Watson Prillcipal
If yes names and ages of siblings I Nomnc y cdad de los hCrl11111 itos
Parent signature Firma del padre Date I Fecha
Dear Pltlrent or Guardian
Throughout the year different orgmizations come to Creighton Elementary wanting to assist our shldents and families with school supplies clothing and other various needs The Family Educational Rights and privacy Act a federal law that make student educational records confidentiat prohibits us from releltlsing student information to these ltlgencies without your permission Tb help us work with these groups in the most efficient way possible we ask that if you are interested in such assistance you complete and sign the form below The form should be rehlmed to Susan Fossler
These assistance programs vary from year to year Giving us permission to release your information does not automatically mean vou will receive assistance It does let ~tS knmj that you would welcome such assistance and would be willing to have your information released to these orgaJ~izations In turn these groups agree to use your information only for the purpose of their assistance program(s) It is also required that your consent for release of information be updated annually If you have a question feel free to contact your childs counselor
Sincerely
Jenny Watson Principal
Shldent name Nomlm dd (studiallte _
Parents names Nombre dc padre 0 cllcl1Ixado __
AddressDirccci611
Phone Tcitfi)ffo
Are there siblings ~Ticllc hermallitos i_- yes sl no noJ
Estimado Padre de Familia 0 encargado
Durante el ano diferentes organizaciones vienen a la escuela Creighton Elementary con eJ objetivo de
ayudar a nuestros estudiantes y sus familia res con utiles escolares ropa y otras necesidades
El Acto de Privacidad y Derechos Educacionales de la Familia una ley federal que hace que los archivos e historial educativo del eshldiante sean confidenciales nos prohibe que divulguemos informacion de estudiantes a tales organizaciones sin e1
permiso suyo Para que nos ayude a trabajar y cooperltlr con esas organizaciones de la manera
mas eficiente Ie pedimos que si LIsted esta interesado (a) en recibir dicho tipo de asistencia 0
ayuda que complete y firme la forma abajo Esta forma la debe de regresar a Susan Fossler
Estos programas de asistencia varian de ano a ano El que nos autorice a dar el permiso pedido no signifiea que recibira ayuda automaticamente Lo que nos indica es que LJsted esta dispuesto (a) a recibir dicha asistencia y que acepta que la informacion suya sea compartida con esas organizaciones Esto pennite a que estos grupos y organizaciones acuerden usar dicha informacion soJamente para e1 prop6sito del program de asistencia Tambien se requiere que renueve este permiso de divulgaci6n de informacion anualmente Si tiene alguna pregunta contacte al consejero (a) de su hijo (a)
Sincerely
Jenny Watson Prillcipal
If yes names and ages of siblings I Nomnc y cdad de los hCrl11111 itos
Parent signature Firma del padre Date I Fecha