Revised March 2015 SWPS Registration Application
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Enrollment Package 2015-2016
Pre-Kindergarten Only
Student Name: ____________________________________________________________________ Last First Middle
Once qualified for the Pre-K program, to officially apply for enrollment, all documents/actions
listed below must be completed and/or submitted.
Forms in this application to be completed by Parents/Students and returned:
1 Student Enrollment Information
2 Emergency Physician and Care Authorization
3 Food Allergy Information
4 Lottery System Acknowledgement
5 Enrollment Verification
6 Parent/Student Handbook & Code of Conduct Acknowledgement
7 Release of Liability for Field Trips/Physical Fitness/Survey/Photo Release
8 Military Connected/Foster Care Questionnaire
9 Family Survey
10 Student Residency Questionnaire
11 Ethnicity and Race Data Questionnaire
12 Home Language Survey
Documentation that needs to be turned in with application:
1 Proof of Residency (Utility, Telephone, or Property Tax Bills; Driver license is not acceptable)
2 Copy of Social Security Card (This disclosure is voluntary and the SS# is used for student ID in PEIMS)
3 Copy of Proof of identity (birth records, driver's license, passport, military id, transcripts, report card, adoption record)
4 Shot Records indicating current immunizations
5 Proof of Guardianship, if applicable (if student does not live with parents)
Final steps for registration:
1 Schedule and complete an interview with SWPS administrator (if this is your first enrollment)
Revised March 2015 SWPS Registration Application
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Southwest Preparatory School
Student Enrollment Information
Date of Enrollment ____/____/____
Section I: Student Applicant Information
Student Name: ___________________________________ __________________ ___________________________________
First Name MI Last Name
SSN#/State ID:________________ ______________ Current Grade Level: _Pre-K_______
Student Address: ________________________________________________________________________________________________ City: __________________________________________State: __________________ Zip:___________ County:_____________________
Home Phone #:_____________________________ Alternate Phone #:_____________________________ Date of Birth: ________________________________ Birth Place: ________________________________________________________ Were you referred to Southwest Preparatory? ___No ___Yes, If yes, by whom: ___________________________________________
If you were not referred to SWP, how did you hear about us? ____ SWPrep Facebook Page _____ Other Internet Website ____ Newspaper ____ Radio _____Previous School ____ Street Banner _____ Summer Camp ____Television ____Business _____Twitter ____Other (please specify)___________________________________
Section II: Student Parent Guardian Information
Student Lives With: __Father and Mother __Stepfather and Mother __Stepmother and Father
__Father Only __Mother Only __Stepfather __Stepmother
__Grandfather __Grandmother __Uncle __ Aunt
__ Cousin __Friend __Self-Sufficient ___Guardian(s) Relation: ___________________
__Other________________________________
1st Parent/Guardian: ______________________________ 2nd Parent/Guardian__________________________________
First, Last Name (1st Parent is always the parent enrolling student) First, MI, Last Name
1st Prnt/Grdn Relationship: ____________________________2nd Prnt/Grdn Relationship: _________________________
2nd Prnt/Grdn Address: _____________________________
1st Prnt/Grdn Home Phone #:___________________________2nd Prnt/Grdn Home Phone #: _______________________
1st Prnt/Grdn Work Phone #: _________________Ext:_____ 2nd Prnt/Grdn Work Phone #: ________________________
1st Prnt/Grdn Cell/Pager #:___________________________ 2nd Prnt/Grdn Cell/Pager #:___________________________
1st Prnt/Grdn-DriverLic#/Issuing State/SSN#/DOB: ________ /________/________________________/_____________
In order to more efficiently communicate with parents/guardians, we would appreciate the opportunity to use e-
mail when possible. Do you have a home e-mail address? ___ Yes ___ No
Would you like access to our Parent Portal? ___ Yes ___ No
What is your e-mail address? ___________________________________________
May the school communicate with you by means of e-mail (regular mailings will continue)? ___ Yes ___ No
Revised March 2015 SWPS Registration Application
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Section III: Student School History Information
Resident School: __________________________________ Resident ISD School District: ________________________ Please note the school/ school district in which the student lives. The school/school district a student resides in is sometimes called the Home District. .
Section IV: Emergency Contacts:
1st Emergency Contact: _______________________2nd Emergency Contact: ___________________________________
1st Contact Relationship: ______________________2nd Contact Relationship: __________________________________
1st Contact Home Phone: _____________________ 2nd Contact Home Phone: _________________________________
1st Contact Work Phone: _____________________ 2nd Contact Work Phone: __________________________________
**Emergency contact information will be verified before enrollment
Section V; Authorized Pick Up
The below listed person are authorized to pick up this student from school:
Name: _______________________________ Relationship: _________________________Phone Number: _____________
Name: _______________________________ Relationship: _________________________Phone Number: _____________
Name: _______________________________ Relationship: _________________________Phone Number: _____________
Parent Signature: _______________________________________ Date: ________________________
Student Signature: _______________________________________ Date:________________________
Revised March 2015 SWPS Registration Application
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Southwest Preparatory School
Emergency Physician and Care Authorization
_________________________________________________ _____ ______ ___________ Student Name (Last) (First) (MI) Sex Grade Date of Birth
Home Address Zip Home Phone
Father’s/Guardian’s Name
Business Name & Address Business Phone
Mother’s/Guardian’s Name
Business Name & Address Business Phone
Student Lives With: Both Parents_____ Mother only______ Father only_____ Other (specify)___________________________________
If parents cannot be contacted please indicate alternate adult(s) whom the school should call. Please indicate relationship (e.g. neighbor, grandparents, etc.)
______________________________________________________________________________________________________________________________________
Alternate Adult Relationship Address Phone
______________________________________________________________________________________________________________________________________
Alternate Adult Relationship Address Phone
Current Health Problems: (Check All That Apply) Past Health Problems: (Check All That Apply)
Cardiac_____ Chicken Pox _____
Asthma_____ Hepatitis _____ A _____ B _____Other_____ Diabetes_____ Mononucleosis_____
Seizure Disorder_____ Surgery (Describe)_________________________________
Blood Disorder_____ ________________________________________________ Other________________________________________________________ ________________________________________________
Severe Drug Allergy_______ ________________________________________________
Name Of Drug And Reaction___________________________________ ________________________________________________ Is Breathing Affected? Yes___ No____ Other:___________________________________________
Severe Food Allergy_________ ________________________________________________
Name Of Food & Reaction_____________________________________ Medications Taken On A Regular Basis: Is Breathing Affected? Yes____ No____ ________________________________________________
Severe Insect Bite Allergy_______ ________________________________________________
Name Of Insect & Reaction____________________________________ ________________________________________________ Is Breathing Affected Yes____ No____ Other Health Problems/Concerns:
Vision Problem_________ _______________________________________________
Type______________________________________________________ _______________________________________________ Glasses Or Contacts? Yes_____ No_____ _______________________________________________
Hearing Problem_________ Date of Last Tetanus Booster:_____________________
Type/Cause_________________________________________________ Hearing Aid Appliance? Yes___ No___
Hearing Loss: Permanent_____ Temporary______
NOTE: PLEASE INITIAL HERE IF THERE ARE NO HEALTH PROBLEMS: ___________
Physician_________________________________________________________________________________ Phone___________________
Dentist___________________________________________________________________________________ Phone___________________
SWPS does not assume any financial responsibility but does wish to provide the best emergency service.
By signing this form you are giving school personnel authority to call EMS or to obtain medical care if you or the alternate adults cannot be reached
and releasing SWPS and its staff from any financial responsibility.
I hereby grant permission for emergency medical care to be given by the attending physician and/or school personnel.
I also give permission for EMS to be called and for my child to be transported as necessary by school or EMS personnel to the nearest hospital.
Under the law, it is the parent/guardians responsibility to update the school with current address and contact information.
Signature of Parent/Guardian_______________________________________________________________ Date_____________________
Revised March 2015 SWPS Registration Application
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Southwest Preparatory School
Food Allergy Information
This form allows you to disclose whether your child has a food allergy or severe food allergy
that you believe should be disclosed to the District in order to enable the District to take
necessary precautions for your child’s safety.
“Severe food allergy” means a dangerous or life-threatening reaction of the human body to a
food-borne allergen introduced by inhalation, ingestion, or skin contact that requires immediate
medical attention.
Please list any foods to which your child is allergic or severely allergic, as well as how your
child reacts when exposed to the food that is listed. The campus will contact you for more
information as needed.
No information to report
Food Nature of Allergic Reaction to Food Life-Threatening?
The district will maintain the confidentiality of the information provided above and may disclose the
information to teachers, school counselors, school nurses, and other appropriate school personnel only
within the limitations of the Family Educational Rights and Privacy Act and District policy.
The district will maintain this form as part of your child’s student record.
Student name:______________________________________ Date of Birth:________________
Grade:_________ School:________________________________________________________
Parent/Guardian Name:___________________________________________________________
Work Phone:_______________ Mobile Phone:_______________ Home phone:_____________
Parent/Guardian Signature___________________________________ Date:________________
Date form received by School Campus:______________________________________________
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Southwest Preparatory School
Lottery System Acknowledgement
Dear Student/Parent/Guardian:
Lottery System
Southwest Preparatory School (SWPS) is an open-enrollment charter school which utilizes a lottery
system for enrollment. A “lottery” is a random selection process that determines the order of enrollment
of student applicants. A lottery is to be conducted if the number of applicants exceeds the maximum
enrollment or if classes are oversubscribed during the application period at any campus. The lottery shall
take place within fifteen days after the closing date of the application period. The principal of each
campus will supervise the lottery and shall post the results immediately after completion. The public is
invited to watch the lottery.
Development of Waiting Lists
Once all openings have been filled through the lottery system for the oversubscribed classes or
campuses, the drawing will continue and randomly – selected numbers will be used to create a waiting
list. As space becomes available, applicants will be called from the waiting list beginning with the
lowest number. Applicants selected by lottery will be admitted and will be enrolled.
Admission Process of Returning Students
Returning students (students who currently attend SWPSD and intend to return the next school year) are
exempted from the lottery if they notify SWPSD of their intent to return the next school year by the end
of the pre-enrollment period.
Applications Submitted Outside the Designated Application Period
If a student applies to SWPSD outside of the designated application period, the student will be placed on
a waiting list in the order of the date in which the application is received. Students applying for
admission in classes undersubscribed or campuses with openings will be admitted on a first-come-first-
serve basis.
Please complete the “Acknowledgment” section of this letter below. Thank you for complying with the
Lottery System.
Sincerely,
Southwest Preparatory School Administration
Acknowledgement: I hereby acknowledge that I have read and understand the SWPS Lottery System.
__________________________________________________
Print Student’s Full Name
______
Student’s Signature Date
__________________________________________________
Print Parent/Guardian Full Name
Parent/Guardian Signature Date
Revised March 2015 SWPS Registration Application
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Southwest Preparatory School
Enrollment Verification
Southwest Preparatory School is an open-enrollment charter school. The charter, awarded by the Texas
Education Agency, governs the operation of the school. The provisions of the charter stipulate that as an
open-enrollment charter school, Southwest Preparatory School will serve the following student
population.
1. Students who are at least 3 years old or have not reached their 26th birthday by September 1.
2. Any eligible student who resides within the boundaries of Bexar County may enroll as well as any
student whose home district is in Boerne ISD, Charlotte ISD, Comal ISD, Comfort ISD, Devine ISD,
D’Hanis ISD, Floresville ISD, Hondo ISD, Navarro ISD, New Braunfels ISD, Pleasanton ISD, Poteet
ISD, Poth ISD, Schertz-Cibolo-Universal City ISD, Seguin ISD, and Stockdale ISD.
3. Students who are 17 years of age, or older, and who are considered school dropouts at the time of
enrollment must have earned a minimum of 17 academic credits before being enrolled as a student.
Students who are 17 years of age or older, a dropout at time of enrollment, and have not earned 17
academic credits must complete their GED prior to enrolling into the diploma program.
4. Students expelled from other public schools and assigned to JJAEP as part of the terms of that
expulsion may not enroll at SWPS until completion of the JJAEP assignment.
5. All students serving or scheduled to serve in an alternative education setting from their previous
school must complete their assignment prior to enrolling at SWPS.
My signature attests that I meet all the requirements for enrolling at SWPS. I have read and clearly
understand the requirements listed above. I understand that my enrollment may be terminated if it is
found that I have misrepresented any enrollment criteria.
_____________________________ _______________ _________________
Student Signature Date Student Date of Birth
_____________________________ _______________
Parent Signature Date
Please complete the following information if you are an adult student (18 or older):
1. I authorize the following parent(s) / guardian(s) to review my educational records:
Print Parent Name(s): 1.___________________________ 2.___________________________
3.___________________________ 4.___________________________
______________________________
Student Signature OR
2. I do not authorize my parent(s) / guardian(s) to review my educational records.
______________________________
Student Signature
Revised March 2015 SWPS Registration Application
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Southwest Preparatory School
Parent/Student Handbook & Code of Conduct Acknowledgement
Dear Student/Parent/Guardian:
The Southwest Preparatory School Trustees officially adopted the Parent/Student Handbook & Code of
Conduct to promote a safe and orderly learning environment for every student.
Students and parents are required to read and discuss the Handbook. Our handbook is available on our
website at www.swprep.org. If you do not have access to the internet, you may review the handbook in
the Front Office of your student’s campus, or we can provide you with a printed copy. Questions about
the rules and consequences may be referred to the student’s teacher, the school counselor, or the campus
administrators for clarification or more detailed explanation.
Students and parents are required to sign this letter below acknowledging receipt and willingness to
comply with the school rules and policies as established by the Southwest Preparatory School
Parent/Student Handbook & Code of Conduct.
Please note that there may be exceptions to the Code of Conduct for students with disabilities whose
ARD committee determines that the code is inappropriate due to the specific disability(ies) of the
student.
Sincerely,
Southwest Preparatory School Administration
We acknowledge that we have received a copy of the Southwest Preparatory School Parent/Student
Handbook & Code of Conduct, and that we have read, discussed, and agree to comply with the rules and
policies established therein.
___________________________________________________________________
Print Student Full Name
____________________________________________________________________
Student Signature Date
____________________________________________________________________
Print Parent/Guardian Full Name
____________________________________________________________________
Parent/Guardian Signature Date
Revised March 2015 SWPS Registration Application
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Southwest Preparatory School
Release of Liability Form - Field Trip/
Physical Fitness Activities/Photographs/Surveys
I,_______________________________, the undersigned parent f______________________________, Print Parent/Guardian’s Full Name Print Student’s Full Name
a resident of the City of , County of , State of
Texas, do hereby authorize my child to participate in Southwest Preparatory School (SWPS) Physical
Fitness/ Field Trip Activities/Surveys/Photos. I agree to release and discharge SWPS, its staff members,
and all others who may be held liable from all claims, present and future, known or unknown, arising
from my child’s participation in school physical fitness and field trip activities for the duration of their
time enrolled with Southwest Preparatory.
I acknowledge that my child has no medical limitations and is fully capable of participating in said activities. I
appoint SWPS to act on my behalf in the event that my child should require emergency medical attention while
participating in a field trip or physical fitness activities. This appointment gives SWPS the authority to sign
releases to physicians who may render medical care if it becomes necessary in case of an emergency.
I agree to assume liability for payment of all professional services and to reimburse SWPS for any
expense that it may incur resulting from any medical services for my child. I hereby agree to hold
SWPS, SWPS employees, and any other agent of SWPS who may act on behalf of SWPS, harmless of
any decision and any injury resulting from such decision concerning the care and treatment of my child.
I agree that if my child’s behavior is such that it disrupts or endangers the welfare of others, SWPS has
my permission to deny him/her participation in such activities. All rules and standards in the student
Code of Conduct apply while on school sponsored activities.
I understand that, teachers and staff may take pictures of my child while engaged in various aspects of
our programs. These pictures may be displayed on the walls in the classroom, on bulletin boards, in a
newsletter, in marketing publications, on the school’s website (www.swprep.org), and in the local
newspaper. My signature below indicates my permission to photograph my child and use the photo or
other digital reproduction of him/her for the publication process, whether electronic, print, or digital.
________________________________ _____________
Printed Name of Parent or Guardian Date
_________________________________ _____________
Signature of Parent or Guardian Date
Revised March 2015 SWPS Registration Application
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Southwest Preparatory School
Military Connected/Foster Care Questionnaire Student Name: _______________________
The Texas Education Agency requires all local education agencies to collect specific data for state
reporting. Please check the appropriate box in each category.
Military Connectedness
____ Not a military connected student.
____ Student is a dependent of a member of the Army, Navy, Air Force, Marine Corps, or Coast Guard
on Active duty.
____ Student is a dependent 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 (Army, Navy,
Air Force, Marine Corps, or Coast Guard)
____Pre-Kindergarten student is a dependent of 1) active duty uniformed member of the Army,
Navy, Air Force, Marine Corps, or Coast Guard, 2) activated/mobilized uniformed member of the Texas
National Guard (Army, Air Guard, or State Guard), or 3) activated/mobilized members of the Reserve
components of the Army, Navy, Marine Corps, Air Force, or Coast Guard, who are currently on active
duty or who were injured or killed while serving on active duty.
Foster Care
____ Student in not currently in the conservatorship of the Department of Family and Protective
Services.
____ Student is currently in the conservatorship of the Department of Family and Protective Services.
____ Pre-Kindergarten student was previously in the conservatorship of the Department of Family
and Protective Services following an adversary hearing help as provided by Section 262.201, Family
Code.
____________________________________________________________________
Print Parent/Guardian Full Name
____________________________________________________________________
Parent/Guardian Signature Date
For Office Use Only
PEIMS Coding
Military Connected 1-Active Duty 2-National Guard 3-Reserves 4-Pre-Kindergarten
Foster Care 1-Foster Care 2-Foster Care-PK
____________
Foster Care/Military Connected Liaison Signature Date
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Date: District: Campus:
Student Name: Date of Birth: Grade Level:
Dear Parents, In order to better serve your children, our school district is helping the State of Texas identify students who may qualify to receive additional educational services. Please answer the following questions and return this form to your child’s school. The information provided below will be kept confidential.
1. Within the past 3 years have you, or your child, moved from one school district, city or state to another? YES or NO
2. If yes, did you, or your child, move so you could work or look for work in agriculture or fishing?
NO (STOP here and return survey to your child’s school.) YES (Please check all that apply below)
Working in a cannery
Working on a dairy farm or ranch.
Working in a fishery
Working on a poultry farm
Working in a plant nursery, orchard,
tree growing or harvesting
Working in a slaughterhouse
Other similar work, please explain: ______________________________________________________
Please complete the following information: (Please print) Best time to contact you: _____________
Parent/Guardian Name: Home Address/Apt Name: City: Zip Code:
Telephone Number: Mailing Address: City: Zip Code:
9
Fruit, vegetables, sunflower, cotton, wheat,
grain, on farms or ranches, fields & vineyards
2015-2016 Family Survey
Revised March 2015 SWPS Registration Application
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Southwest Preparatory School
Student Residency Questionnaire
Name of Student: ____________________________________ Sex: Male Female
Date of Birth: ____/_____/_____ Age: _____ Social Security Number: _____________________
1. Is your current address a temporary arrangement? Yes No
If you answered YES to the above questions, please complete the remainder of this form.
If you answered NO, then stop here.
Where is the student presently living? Please check the appropriate box.
Caregiver(s) who are not legal guardians (Example: friends, relatives, parents of friends, etc.)
In a motel
In a shelter
Moving from place to place
In a place not designed for ordinary sleeping accommodations such as s car, park, or campsite
Foster Care
Other ____________________________________
Name of Person student resides with: _____________________________________________________
Address: ____________________________________________________________________________
City: ______________________________________________ Zip: __________________________
Home Phone #: _________________ Cell Phone #: ________________ Other Phone #: ____________
Presenting a false record or falsifying records is an offense under Section 37.10, Penal Code, and
enrollment of the child under false documents subjects the person to liability for tuition or other costs.
_________________________________________________________ ________________
Signature of Parent/Legal Guardian/Caregiver/Unaccompanied Student Date
For School Use Only
PEIMS Coding Homeless Status 1-Sheltered 2-Doubled Up 3-Unsheltered 4-Motel/Hotel
Unaccompanied Youth 0-Not Unaccompanied 1-Unaccompanied-Received Srvs 2- Unaccompanied-No Srvs.
Foster Care 1-Yes 2-No
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
Revised March 2015 SWPS Registration Application
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Texas Education Agency
Texas Public School Student/Staff 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 the data for federal reporting.
Please answer both parts of the following questions on the student’s or staff member’s ethnicity and race. United States Federal Register (71 FR 44866)
Part 1. Ethnicity: Is the person Hispanic/Latino? (Choose only one)
Hispanic/Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
Not Hispanic/Latino
Part 2. Race: What is the person’s race? (Choose one or more)
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.
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.
Black or African American - A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
________________________________
Student/Staff Name (please print)
________________________________
(Parent/Guardian)/(Staff) Signature
________________________________
Student/Staff Identification Number
________________________________ Date
This space reserved for Local school observer – upon completion and entering data in student software system, file this form in student’s permanent folder.
Ethnicity – choose only one: _____ Hispanic / Latino _____ Not Hispanic/Latino
Race – choose one or more: _____ American Indian or Alaska Native _____ Asian _____ Black or African American _____ Native Hawaiian or Other Pacific Islander _____ White
Observer signature:
Campus and Date:
Texas Education Agency – March 2010 (last update)
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Southwest Preparatory School
Home Language Survey
Student Name: ____________________________________________________________
School: Southwest Preparatory School Grade: __Pre-Kindergarten___________
TO BE COMPLETED BY PARENT OR LEGAL GUARDIAN:
(1.) What language is spoken in your home most of the time? ____________________________
(2.) What language does your child speak most of the time? ____________________________
_______________________________________ ____________________
Parent/Guardian Signature Date
What language do you prefer to recieve coorespondance from the school in? ______________________
Quetionario De Idioma Hogarido
Nombre del Estudiante: __________________________________________________
Escuela: Southwest Preparatory School Grado: _______________
DEBE DE COMPLETARSE POR EL PADRE OR GUARDIAN
(1.) ¿Cual es el idioma que mas se hable en su hogar? ___________________________
(2.) ¿Cual es el idioma que mas habla su nino(a)? _______________________________
__________________________________ ____________________
Firma Del Padre O Guardian Fecha
Office use only: In the event the primary language is other than English notification to the ESL Coordinator is
required by scanned copy of this document within 24 hours of enrollment.
_______________________________________ ____________________
Staff Signature Date scanned
Student enrolling in a Texas public school for the first time.