2020-2021 registration/application packet

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Page 1 of 18 BUFFALO PUBLIC SCHOOLS Central Registration Center Office of Student Placement & Registration Ms. Kelli Daniels, Director 33 Ash Street Buffalo, New York 14204 Phone (716) 816-3717 Fax (716) 816-3993 Email: [email protected] Dear Parent/Guardian: On behalf of the Board of Education, the Superintendent, staff, and myself, it is with great enthusiasm that I welcome you to Buffalo Public Schools for the 2020 -2021 school year! The enrollment process typically would start with a visit to the Central Registration Center (CRC). During this time of COVID-19, CRC is closed, however, we are still here for you. The following instructions explain the 4 steps necessary to enroll your child in the Buffalo Public School District: Step 1: Complete the following 2020-2021 Registration/Application Packet. Step 2: Photocopy all required registration documents - please refer to page 4 of the registration packet: Child’s Proof of Birth Two Proofs of Address Parent/Guardian Photo Identification Immunization Record(s) (if available) Health Physical Examination (if available) Custody Document(s) (if applicable) Current Report Card and/or Final Transcript Step 3: Bring the Registration/Application Packet & all required documentation in a folder/envelope to the Central Registration Center, 33 Ash Street, Buffalo, NY 14204 (Spruce Street entrance). Packets can be dropped off Monday Friday from 8:00 a.m. 3:00 p.m. Please note: If you have multiple children, each child needs a separate Registration/Application Packet. Please place all required documents in the same envelope/folder. Step 4: Upon arrival, place the folder/envelope with the Registration/Application Packet & all required documentation in the registration drop box at the door located at the entrance of the building (incomplete packets or missing documentation will result in processing delays). For safety precautions, please ensure you are wearing a mask. Once you have submitted your documents, you will be required to immediately leave the premises so that the next family can be serviced. You will not be allowed to congregate on the premises, as we must adhere to the NYS Social Distancing Requirements. If you have any questions or concerns regarding the enrollment process, please call 816-3717 or email: [email protected]. We look forward to working with you and your family! *Students in temporary housing, as defined by McKinney-Vento, are not required to submit registration documents in order to enroll. For assistance with registration and eligibility guidelines or if you have questions, please contact the McKinney-Vento Department at [email protected] or 716-816-3717, Ext. 3. Sincerely, Ms. Kelli A. Daniels Director of Student Placement & Registration

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Page 1: 2020-2021 Registration/Application Packet

Page 1 of 18

BUFFALO PUBLIC

SCHOOLS

Central Registration Center

Office of Student Placement & Registration

Ms. Kelli Daniels, Director

33 Ash Street

Buffalo, New York 14204

Phone (716) 816-3717 Fax (716) 816-3993

Email: [email protected]

Dear Parent/Guardian:

On behalf of the Board of Education, the Superintendent, staff, and myself, it is with great enthusiasm that I welcome you

to Buffalo Public Schools for the 2020 -2021 school year! The enrollment process typically would start with a visit to the

Central Registration Center (CRC). During this time of COVID-19, CRC is closed, however, we are still here for you.

The following instructions explain the 4 steps necessary to enroll your child in the Buffalo Public School District:

Step 1: Complete the following 2020-2021 Registration/Application Packet.

Step 2: Photocopy all required registration documents - please refer to page 4 of the registration packet:

Child’s Proof of Birth

Two Proofs of Address

Parent/Guardian Photo Identification

Immunization Record(s) (if available)

Health Physical Examination (if available)

Custody Document(s) (if applicable)

Current Report Card and/or Final Transcript

Step 3: Bring the Registration/Application Packet & all required documentation in a folder/envelope to the Central

Registration Center, 33 Ash Street, Buffalo, NY 14204 (Spruce Street entrance). Packets can be dropped off

Monday – Friday from 8:00 a.m. – 3:00 p.m. Please note: If you have multiple children, each child needs a

separate Registration/Application Packet. Please place all required documents in the same

envelope/folder.

Step 4: Upon arrival, place the folder/envelope with the Registration/Application Packet & all required

documentation in the registration drop box at the door located at the entrance of the building (incomplete

packets or missing documentation will result in processing delays). For safety precautions, please ensure you are

wearing a mask. Once you have submitted your documents, you will be required to immediately leave the premises so that

the next family can be serviced. You will not be allowed to congregate on the premises, as we must adhere to the NYS

Social Distancing Requirements.

If you have any questions or concerns regarding the enrollment process, please call 816-3717 or email:

[email protected]. We look forward to working with you and your family!

*Students in temporary housing, as defined by McKinney-Vento, are not required to submit registration documents in order to enroll. For assistance with

registration and eligibility guidelines or if you have questions, please contact the McKinney-Vento Department at [email protected] or

716-816-3717, Ext. 3.

Sincerely,

Ms. Kelli A. Daniels Director of Student Placement & Registration

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Page 3: 2020-2021 Registration/Application Packet

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BUFFALO PUBLIC SCHOOLS

2020-2021 REGISTRATION/APPLICATION PACKET

Before proceeding please answer the following question regarding the child you are registering for school:

Last Name: ____________________________ First Name: ________________________

DOB: _______________

Where is the student currently living? The answer you give below will help the district

determine what services you or your child may be able to receive under the McKinney-Vento

Act. Students who are protected under this Act are entitled to immediate enrollment in school

even if they do not have the documents normally needed for registration.

Check: Housing Questionnaire

1. In permanent housing: the child’s housing is fixed, regular and

adequate…a fixed residence is one that is stationary, permanent, and not

subject to change

2. Doubled Up: Living with family member or another person due to

loss of housing or as a result of economic hardship

3. Shelter: Emergency or transitional shelter

4. Hotel/Motel: Living in what is NOT an emergency or transitional

shelter and involves payment

5. Other Temporary Living Situation: Trailer park, campground, car,

park, public places, abandoned building, street, or any other inadequate

living space

6. Unaccompanied Youth: Youth who is not in the physical custody of

a parent or guardian

For assistance with registration and eligibility guidelines or if you have questions, please contact the McKinney-Vento

Department at [email protected] or 716.816.3717, ext. #3.

OFFICE USE ONLY:

McKinney Vento Eligible: Yes:______ No:_______ Date: ________________ MV Staff Initials: _________

Student ID#: _________________________ Magnet ID# _________ Registration Clerk Initials: __________

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BUFFALO PUBLIC SCHOOL DISTRICT

Documents Required to Complete the Registration Process

Please ensure all REQUIRED documents are attached. If the REQUIRED documents are not enclosed or the registration packet is incomplete, your child’s registration may be delayed.

REQUIRED: One (1) Proof of birth/child’s age: birth certificate, passport, I-94 card, or hospital certificate REQUIRED: One (1) Document that links the child to the parent/guardian: birth certificate, I-94 card with family home page, current copy income tax form filed, or custody papers REQUIRED: One (1) Parent/guardian’s photo identification: Valid Driver License, Non-Driver Identification Card, Valid Learner Permit, Erie County Department of Social Services (ECDSS) Benefit Card, Employee Identification Card, Birth Certificate Card, or Membership Card that has not expired

REQUIRED: TWO (2) proofs of address from the list below to verify the parent/guardian resides in

the City of Buffalo School District: Below there are 9 (nine) categories to choose from - You may only use one (1) proof of address from each category

Valid NYS Driver License, Non-Driver Identification card, or NYS Learner Permit that has not expired

Residential Utility Bill (gas, electric or cable) issued by a utility company (such as National Grid, Spectrum, or National Fuel) within the past 30 days

Official payroll documentation from an employer issued within the last 30 days, such as a pay stub with the home address

Notice of Decision Statement from the Erie County Department of Social Services (within the year of date – not expired - example; ECDSS Budget Sheet with the home address)

Documentation/letter on letterhead from a federal, state, or local government agency including the IRS, the City Housing Authority, or Office of Refugee Resettlement within the past 60 days

Signed residential lease within the last year

Bank Statement (Mortgage, Checking, Savings, or Credit Card) with address within the past 30 days

Valid Vehicle Registration

Valid Voter Registration Card

PREFERRED: Report Card for students entering grades 1 - 8 and transcript for students entering grades 9 – 12 (Student Placement & Registration will request your child’s academic records from their prior school if not included – this may delay processing)

PREFERRED: IEP- Individualized Education Program document for Special Education Students (The Department of Special Education will request your child’s IEP from their prior school if not included- this may delay processing)

PREFERRED: 504/ADA (American Disability Act) (Student Placement & Registration will request the document from your child’s prior school if not included)

OPTIONAL: Up-to-Date Immunization Record (required 14 days after start of school)

OPTIONAL: Latest Physical Examination (required 30 days after start of school)

CUSTODY OR COURT DOCUMENTS IF CHILD DOES NOT RESIDE WITH BIRTH PARENT(S)

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BUFFALO PUBLIC SCHOOL STUDENT ENROLLMENT FORM 2020-2021:

Office Use Only: STUDENT INFORMATION: STUDENT ID#: __________________ MAGNET #:__________ Last Name: __________________________ First Name: _________________ Middle Name: _____________ Date of Birth: ____________________ Gender: Male: _____ Female: _____ Twin: Yes: ____ No: ____

Is the Student Hispanic, Latino or of Spanish Origin? ________Yes, Hispanic

________No, not Hispanic

Select one or more races: ________American Indian or Native American ________Asian ________ Black _______White _______Native Hawaiian or Other Pacific Islander

STUDENT SCHOOL INFORMATION: Has this student ever received ENL or Bilingual services? Yes: _____ No: ______

If yes, indicate service: ___________________

Does the student currently receive Special Education Services? Yes: _____ No: ______

If yes, indicate service: ___________________

Does the student receive 504/ADA (American Disability Act) services? Yes: _____ No: ______ Has your child ever attended a Buffalo Public School? Yes: _______ No: ________ Current Grade Level 2020-2021: _________ Previous School Attended: ____________________________________________________________________ Previous School Address: _____________________________________________________________________ Previous School City/State/Zip: ________________________________________________________________ Previous School Phone Number: ( ) ________________________ Previous School Fax Number: ( ) ________________________ Dates of Attendance at Previous School: ________________________ through ________________________ Has your child ever been suspended/expelled from any former school? Yes: _______ No: _______

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SCHOOL CHOICE SELECTIONS - 2020-2021 School Year: Please indicate school choices for your child based on the schools listed on pages 15 to 18. School Number/Name: __________________________________________ School Program: _____________ School Number/Name: __________________________________________ School Program: _____________ School Number/Name: __________________________________________ School Program: _____________ School Number/Name: __________________________________________ School Program: _____________ School Number/Name: __________________________________________ School Program: _____________ STUDENT/PARENT/SIBLING HOUSEHOLD INFORMATION:

HOUSEHOLD INFORMATION: (POST OFFICE BOX IS NOT AN ACCEPTABLE ADDRESS) Household Address: ______________________________________________________________________

City: __________________ State: ________ Zip: ________ Primary Phone Number: ( ) ____________________

PARENT/GUARDIAN: Parent/Guardian who resides at the same address as student. Parent/Guardian Name: _______________________________ Male: ____ Female: _____ Relationship to child: ____________

Phone Number: ( ) ________________________ Email: ____________________________________________________

Please indicate if the Parent/Guardian is a Migrant Worker: Yes: __________ No: __________ Parent/Guardian Name: _______________________________ Male: ____ Female: _____ Relationship to child: ____________

Phone Number: ( ) ________________________ Email: ____________________________________________________

Please indicate if the Parent/Guardian is a Migrant Worker: Yes: __________ No: _________

ADDITIONAL GUARDIAN INFORMATION: PARENT/GUARDIAN: (ONLY complete if other parent/guardian does not reside with student) Parent/Guardian Name: _______________________________ Male: ____ Female: _____ Relationship to child: ____________ Address: ________________________________________________________________________________

City: ___________________ State: _______ Zip: ___________ Primary Phone Number: ( ) _______________________ Email: ____________________________________________________________________________________________________ Please indicate if the Parent/Guardian is a Migrant Worker: Yes: ____________ No: ____________

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SIBLING/CO-APPLICANT INFORMATION: Please list all information below for all brothers and/or sisters ATTENDING SCHOOL and living in the same household as the student enrolling in school.

Co-Applicant (Co-App): is defined as a sister/brother of child that is also applying to attend a BPS. Current BPS: is defined as a sister/brother of child that is currently enrolled and attending a Buffalo Public School (BPS). Name: ________________________________________ DOB: ______________ Grade for 2020-2021 _________Gender: _______ Indicate: Co-App_____ Current BPS______ Office Use Only: Magnet#______________ Name: ________________________________________ DOB: ______________ Grade for 2020-2021 _________Gender: _______ Indicate: Co-App_____ Current BPS______ Office Use Only: Magnet#______________ Name: ________________________________________ DOB: ______________ Grade for 2020-2021 _________Gender: _______ Indicate: Co-App_____ Current BPS______ Office Use Only: Magnet#______________ Name: ________________________________________ DOB: ______________ Grade for 2020-2021 _________Gender: _______ Indicate: Co-App_____ Current BPS______ Office Use Only: Magnet#______________ Name: ________________________________________ DOB: ______________ Grade for 2020-2021 _________Gender: _______ Indicate: Co-App_____ Current BPS______ Office Use Only: Magnet#______________

Emergency Contact Information: Please list person(s) OTHER THAN PARENTS we may contact if the parent(s)

or guardian(s) cannot be reached. These individuals have permission to make decisions concerning your child in the event of an emergency and to pick your child up from school.

Name:_________________________________________________________________ Gender: Male: _____ Female: _____

Phone Number: ( )________________________ Relationship to child: ______________________________

Name:_________________________________________________________________ Gender: Male: _____ Female: _____

Phone Number: ( )________________________ Relationship to child: ______________________________

Name:_________________________________________________________________ Gender: Male: _____ Female: _____

Phone Number: ( )________________________ Relationship to child: ______________________________

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Information of Rights of Parent from the Family Education Rights and Privacy Act (FERPA) An educational agency or institution shall give full rights under the Act to either parent, unless the agency or institution has been provided with evidence that there is a court order, state statute, or legally binding documents relating to such matters as divorce, separation or custody that specifically revokes these rights. (Authority: 20 U.S.C. 1232g) Please check the current custody/guardianship arrangement:

□ Parent/Guardians are together residing at the same residence.

□ Single parent (father and mother ARE listed on the birth certificate)

□ Single parent (i.e. father IS NOT listed on the birth certificate)

□ Parent/Guardians divorced/separated – Joint Custody (legal documentation must be provided if there is a dispute over

primary residential address)

□ Parent/Guardian divorced/separated – Sole Custody (legal documentation must be provided)

□ Parents have never been married and no legal custody papers

□ Custody/Guardianship is transferred by the courts (legal documentation must be provided)

□ Restricted pickup (legal documentation must be provided)

□ Student is emancipated (legal documentation must be provided)

Please check all that apply:

□ I have disclosed my current custody/guardianship arrangement

□ I have attached a copy of the legal current court documents that describe custody arrangements.

□ No legal documents that describe custody arrangements exist

□ I understand that it is my responsibility to update my child’s school of changes in custody

Please note: Central Registration Office is responsible for registration, not determining which parent or guardian may check a child in/out of school. If custodial or guardianship issues exist when you register your child in the Buffalo Public School District, it is your responsibility to provide custodial documentation to the Student Placement & Registration Office and a copy will scanned into the BPS Student Information System. In addition: If a change of custody is made after a student is enrolled and attending a Buffalo Public School, you are responsible to provide the documentation directly to the school. You do not bring it to Central Registration.

Please keep your child’s school informed of any changes in custodial arrangements

SIGNATURE OF PARENT/GUARDIAN: X_________________________________________ DATE: X_______________________________

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STATE EDUCATION DEPARTMENT/ THE UNIVERSITY OF THE STATE OF NEW YORK / ALBANY, NY 12234 Office of P-12

Elisa Alvarez, Associate Commissioner Office of Bilingual Education and World Languages

55 Hanson Place, Room 594 89 Washington Avenue, Room 528EB Brooklyn, New York 11217 Albany, New York 12234 Tel: (718) 722-2445 / Fax: (718) 722-2459 Tel: (518) 474-8775 / Fax: (518) 474-7948

Home Language Questionnaire (HLQ) Dear Parent or Guardian: In order to provide your child with the best possible education, we need to determine how well he or she understands, speaks, reads and writes in English, as well as prior school and personal history. Please complete the sections below entitled Language Background and Educational History. Your assistance in answering these Questions is greatly appreciated. Thank you.

Please write clearly when completing this section. STUDENT NAME:

First Middle Last

DATE OF BIRTH: GENDER:

MALE FEMALE

Month Day Year

PARENT/PERSON IN PARENTAL RELATION INFO:

LAST NAME FIRST NAME RELATION TO STUDENT

HOME LANGUAGE CODE

Language Background (Please check all that apply)

1. What language’s is(are) spoken in the student’s home or resident? □ English □ Other_________________________________

___ Specify

2. What was the first language your child learned? □ English □ Other____________________________________

Specify

3. What is the Home Language of each parent/guardian? □ Mother _______________ specify

□ Father __________________ Specify

□ Guardian(s) _______________________________________________________ Specify

4. What language(s) does your child understand? □ English □ Other________________________________ Specify

5. What language(s) does your child speak? □ English □ __________________ Does not speak Specify

6. What language(s) does your child read? □ English □ __________________ Does not read Specify

7. What language(s) does your child write? □ English □ __________________ Does not write Specify

THIS SECTION TO BE COMPLETED BY DISTRICT IN WHICH STUDENT IS REGISTERED

SCHOOL DISTRICT INFORMATION: STUDENT ID NUMBER IN NYS STUDENT INFORMATION SYSTEM:

BUFFALO CITY SCHOOL DISTRICT 712 CITY HALL-65 NIAGARA SQUARE (140600) BUFFALO, NY 14202 716-816-3500

District Name (Number) & School Address

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Home Language Questionnaire (HLQ)----Page Two

___________________________________________________________ Month: Day:______Year:__________

Signature of Parent or of Person in Parental Relation DATE

Relationship to student: Mother Father Other: _____________________________________________

OFFICIAL ENTRY ONLY – NAME/POSITION OF PERSONNEL ADMINISTERING HLQ

NAME: __________________________________________________________ POSITION: ___________________________________________________________ IF AN INTERPRETOR IS PROVIDED, LIST NAME, POSITION AND CREDENTIALS:

NAME/POSITION OF QUALIFIED PERSONNEL REVIEWING HLQ AND CONDUCTING INDIVIDUAL INTERVIEW

NAME: __________________________________________________________ POSITION: ___________________________________________________________

ORAL INTERVIEW NECESSARY: No Yes **DATE OF INDIVIDUAL INTERVIEW: _________________________________ MO DAY YR

OUTCOME OF ADMINISTER NYSITELL

INDIVIDUAL ENGLISH PROFICIENT

INTERVIEW REFER TO LANGUAGE PROFICIENCY TEAM

NAME/POSITION OF QUALIFIED PERSONNEL ADMINISTERING NYSITELL

NAME: __________________________________________________________ POSITION: ___________________________________________________________ DATE OF NYSITELL PROFICIENCY LEVEL

ADMINISTRATION: ACHIEVED ON ENTERING EMERGING TRANSITIONING EXPANDING COMMANDING ____________________________ NYSITELL: MO DAY YR

FOR STUDENTS WITH DISABILITIES, LIST ACCOMODATIONS, IF ANY, ADMINISTERED IN ACCORDANCE WITH IEP PURSUANT TO CSE RECOMMENDATION:

2 ENGLISH

Educational History

8. Indicate the total number of years that your child has been enrolled in school _________________________

9. Do you think your child may have any difficulties or conditions that affect his or her ability to understand, speak, read or write in English or any

other language? If yes, please describe them.

Yes* No Not Sure

*If yes, please explain:_______________________________________________________________________

How severe do you think these difficulties are? Minor Somewhat Severe Severe

10a. Has your child ever been referred for a special education evaluation in the past? No Yes* Please complete 10b below.

10b. *If referred for an evaluation, has your child ever received any special education services in the past?

No Yes – Type of services received: __________________________________________________________________________

Age at which services received (Please check all that apply):

Birth to 3 years (Early intervention) 3 to 5 years (Special Education) 6 years or older (Special Education)

10c. Does your child have an Individualized Education Program (IEP)? No Yes 11. Is there anything else you think is important for the school to know about your child? (e.g., special talents, health concerns, etc.)

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________ 12. In what language(s) would you like to receive information from the school?_________________________________________________

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Buffalo Public Schools - Department of Social and Emotional Wellness Support HEALTH HISTORY

CHILD’S NAME _____________________________________________D.O.B. ________________________________________

M.D. / Clinic _____________________________________Address ________________________Phone ____________________

PLEASE ANSWER THE FOLLOWING QUESTIONS AND EXPLAIN YES ANSWERS: Is your child under medical care now? __________________________________________________________________________ Is student taking any medication? ___________________________during regular School Hours? ___________________________ Name __________________________________________________ Dosage______________________ Frequency _____________ Allergies: __________________________________________________________________________________________________

Does your child have Asthma? Yes No

Has your child ever had episodes of wheezing, shortness of breath or frequent day or night coughing? Yes No

Have you heard your child wheeze or cough after active playing? Yes No Is the student able to participate in gym classes? ___________________________________________________________________

HAS YOUR CHILD EVER HAD ANY OF THE FOLLOWING?

Yes No Yes No

BLOOD HEAD/NERVOUS SYSTEM

Anemia Head Injuries/Frequent Headaches

Lead Problems Hyperactivity

Other Seizures

COMMUNICABLE Other

Chickenpox LUNGS

Hepatitis Allergies/Hay Fever

Rheumatic Fever Asthma

Tuberculosis Chronic Cough/Pneumonia/Bronchitis

Other Other

EAR, NOSE, THROAT MOUTH

Frequent Ear Infections/Tubes Dental Problems

Frequent Sinus Infections/Nose Bleeds Speech Problems

Hearing Problems Other

Other MUSCLE/BONES

EMOTIONAL/SOCIAL PROBLEMS Bone Problems/Broken Bones

Behavior Problems Muscle Problems

Emotional Problems Scoliosis/Back Problems

Psychological Testing Other

Other SKIN

ENDOCRINE Allergies/Eczema

Diabetes/Hypoglycemia Rashes/Problems

Growth Problems STOMACH/INTESTINE

Thyroid Bowel Problems

Other Frequent Stomachaches

EYES Other

Lazy Eye/Crossed/Surgery URINARY/REPRODUCTIVE SYSTEM

Vision Problems/Glasses/Lenses Kidney Problems/Urinary Tract Problems

Other Testicles: Injury/Surgery/Hernia

HEART Wetting/Frequent Urination

Heart Murmur/Disease/Surgery Other

High Blood Pressure

Other

If you have answered YES to any of the above questions, or your child is on any medication or treatment – please explain:

Parent/Guardian Signature: Date: X

Health History Form Revised 1/22/2020

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BUFFALO PUBLIC SCHOOLS

Family Health History and Health Appraisal Questionnaire

Directions: Sometimes people have stressful events happen to them. READ the list of stressful things

below and click “YES” for each event that has EVER happened to YOUR CHILD. Click “NO” if it has

NEVER happened to YOUR CHILD. Some questions will ask them about what they SAW happen to

someone else, while other questions ask about what actually happened to THEM.

(Please do not include things they may have only heard about on TV, media or from someone else. Only

answer what has happened to them in real life.)

SAMPLE: Have you EVER gone to a basketball game?

Have any of the following events EVER happened to YOUR CHILD? (Click: YES or NO)

1. Has your child ever BEEN IN a serious accident, where they could have been badly hurt

or even killed?

2. Has your child ever SEEN a serious accident, where someone could have been (or was)

badly hurt or died?

3. Has your child thought that you or someone you know would get badly hurt during a

natural disaster such as a hurricane, flood, or earthquake?

4. Has ANYONE close to your child ever been SERIOUSLY ill or injured?

5. Has anyone close to your child died?

6. Has your child had a serious illness or injury, or had to be rushed to the hospital?

7. Has your child had to be separated from his/her parent/guardian (or someone he/she

depends on) for more than a few days, when they DID NOT WANT TO BE?

8. Has your child ever been attacked by a dog or another animal?

9. Has anyone told your child that he/she were going to hurt him/her?

10. Has your child SEEN someone else being told they were going to be hurt?

11. Has your child ever been slapped, punched, or hit by someone?

12. Has your child SEEN someone else being slapped, punched, or hit by someone?

13. Has your child ever been beaten up?

14. Has your child ever SEEN someone else getting beaten up?

15. Has your child SEEN someone else being attacked or stabbed with a knife?

16. Has your child SEEN someone else pointing a real gun at someone else?

17. Has your child SEEN someone else being shot at or shot with a real gun?

The Family Health History and Health Appraisal questionnaires were used to collect information on child abuse and neglect, household challenges,

and other socio-behavioral factors in the original CDC-Kaiser ACE Study. “More detailed information about the ACE Study’s methodology,

including survey development, can be found in “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of

Death in Adults,” published in the American Journal of Preventive Medicine in 1998, Volume 14, pages 245-258.

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BUFFALO PUBLIC SCHOOLS

HEALTH RELEASE OF INFORMATION FORM

This form allows exchange of important health information for your child between the School Nurse and their Medical

Providers. All records obtained will be kept confidential. Please contact your School Nurse if you have any questions.

ONLY COMPLETION OF SECTIONS 1 AND 4 ARE NECESSARY

SECTION 1 Student’s Name: Date of Birth:

Parent/Guardian’s Name:

Student/Parent/Guardian’s Address:

City: State: Zip Code

Parent/Guardian Phone Number:

I hereby authorize the release of information necessary for health care to:

Return to: Buffalo Public School District – School Nurse and Department of Social and Wellness

Support

School Address and

Information:

FROM

Health Care Provider

Address

Phone/Fax

Regarding Name

Specific Information

SECTION 4 Signature of Parent/Guardian

Relationship to Student

Date

Health History Form Revised 1/22/2020

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BUFFALO PUBLIC SCHOOLS

2020-2021 ELEMENTARY& HIGH SCHOOL CHOICE(S)

ALL ASSIGNMENTS CARRY A ONE-YEAR COMMITMENT, NO EXCEPTIONS

SCHOOL

NUMBER

SCHOOL NAME

SCHOOL ACCOUNTABILITY

STATUS

ADDRESS

TELEPHONE PROGRAM CODES GRADES

UNIFORM

SCHOOL

SCHEDULE

003

Community

School

D’Youville Porter Campus School

Accountability status: Good Standing 255 Porter Ave (716) 816-3120

EIM = English Dominant

SIM = Spanish Dominant PK-4

Uniform 9:00am-3:55pm BLN = Bilingual (Spanish only) 5-6

GEN = General Education K-8

006

Buffalo Elementary School of

Technology

Accountability status: Good Standing

414 S Division St.

(716) 816-3767 GEN = General Education PK-8

No Uniform

8:00am-2:55pm

017 Early Childhood Center

Accountability status: Good Standing

1045 W Delavan

Ave

(716) 816-3150

GEN = General Education PK-4 Uniform

9:00am-4:05pm

018

Dr. Antonia Pantoja Community School

Accountability status: Targeted Support &

Improvement (TSI)

750 West Ave (716) 816-3160

GEN = General Education PK-8 No Uniform

8:55am-3:55pm

019

Native American Magnet

Accountability status: Targeted Support &

Improvement (TSI)

97 W. Delavan Ave

(716) 816-3180 GEN = General Education PK-8

No Uniform

8:00am-2:55pm

027 Hillery Park Elementary

Accountability status: Good Standing 73 Pawnee Pkwy (716) 816-4770

GEN = General Education PK-8 Uniform

9:00am-3:55pm

030

Community

School

Frank A. Sedita Elementary

Accountability status: Good Standing

21 Lowell Pl.

(716) 816-3220

EIM = English Dominant

SIM = Spanish Dominant PK -5

Uniform

9:00am-3:55pm BLN = Bilingual (Spanish only) 6

GEN = General Education PK-8

031

Harriet Ross Tubman Elementary

School

Accountability status: Comprehensive Support & Improvement (CSI)

212 Stanton St

(716) 816-3780 GEN = General Education PK-8

Uniform

9:00am-3:55pm

032

Bennett Park Montessori School

Accountability status: Targeted Support & Improvement (TSI)

342 Clinton St

(716) 816-4603 GEN = General Education 3Y-8

No Uniform

9:00am-3:55pm

033 Bilingual Center

Accountability status: Good Standing 157 Elk St (716) 816-4783

EIM = English Dominant

SIM = Spanish Dominant PK-6 Uniform

8:00am-2:55pm GEN = General 4-8

037

Community School

Marva J. Daniel Futures Preparatory

School

Accountability status: Comprehensive

Support & Improvement (CSI)

295 Carlton St

(716) 816-3800 GEN = General Education PK-8

Uniform

8:00am-2:55pm

043

Community

School

Lovejoy Discovery School

Accountability status: Comprehensive

Support & Improvement (CSI)

161 Benzinger St (716) 816-3260

GEN = General Education PK-8 No Uniform

9:00am-3:55pm

045 International School

Accountability status: Good Standing 141 Hoyt St (716) 816-3300

GEN = General Education PK-8 No Uniform

9:00am-3:55pm

048

School #48 at Dr. Martin Luther King,

Jr. #39

Accountability status: TBD

487 High St

(716) 816-3240

SIM = Spanish Dominant students only

PK-4 No Uniform

9:00am-3:55pm GEN = General Education

050

Community School

North Park Community School

Accountability status: Good Standing

780 Parkside Ave

(716)816-3440 GEN= General Education PK-2

No Uniform

9:00- 3:55 pm

053 Community School #53

Accountability status: Good Standing

329 Roehrer Ave

(716) 816-3330 GEN = General Education PK-8

Uniform

9:00am-3:55pm

054

Dr. George Blackman Early Childhood

Center

Accountability status: Good Standing

2358 Main St

(716) 816-3340 GEN = General Education PK-4

Uniform

9:00am-3:55pm

159

Community School

Dr. Charles R. Drew Science Magnet–

Annex

Accountability status: Good Standing

50 A St

(716) 816-4120 GEN = General Education PK-2

Uniform

8:00am-2:55pm

059

Community School

Dr. Charles R. Drew Science Magnet–

Museum

Accountability status: Good Standing

1 MLK Jr Park

(716) 816-3370 GEN = General Education 3-8

Uniform

8:00am-2:55pm

Page 16: 2020-2021 Registration/Application Packet

Page 16 of 18

061 Arthur O. Eve Early Childhood

Performing Arts School of Distinction

Accountability status: Good Standing

453 Leroy Ave

(716) 816-3400

EPA = Exploratory Performing Arts

(Dance, Music, Theater, & Visual Arts) PK-4

Uniform

9:00am-3:55pm

GAT=Gifted and Talented* K-4

064 Frederick Law Olmsted School

Accountability status: Good Standing 874 Amherst St (716) 816-3420

C/W = Citywide

N/H = Neighborhood EIM = English Dominant

SIM = Spanish Dominant

PK-4 No Uniform 8:00am-2:55pm

GAT – Gifted and Talented* K-4

065 Roosevelt Early Childhood Center

Accountability status: Good Standing 249 Skillen St (716) 816-3430

GEN = General Education PK-4 No Uniform

9:00am-3:55pm

067 Discovery School

Accountability status: Good Standing

911 Abbott Rd

(716) 816-4922

C/W = Citywide

N/H = Neighborhood PK-8

No Uniform

8:00am-2:55pm

069 Houghton Academy

Accountability status: Good Standing 1725 Clinton St (716) 816-4794

GEN = General Education PK-8 No Uniform 9:00am-3:55pm

072 Lorraine Elementary

Accountability status: Good Standing

71 Lorraine Ave

(716) 816-4809 GEN = General Education PK-8

Uniform

8:00am-2:55pm

074

Community School

Hamlin Park Claude & Ouida Clapp

Academy

Accountability status: Good Standing

126 Donaldson Rd

(716) 816-3490 GEN = General Education PK-8

Uniform

9:00am-3:55pm

076

Community

School

Herman Badillo Bilingual Academy

Accountability status: Good Standing

315 Carolina St

(716) 816-3848

GEN = General Education PK-8 Uniform

8:00am-2:55pm SIM = Spanish Dominant students only PK-6

079

Pfc. William J. Grabiarz School of

Excellence

Accountability status: Comprehensive

Support & Improvement (CSI)

225 Lawn Ave (716) 816-4040

GEN = General Education PK-8 Uniform

8:00am-2:55pm

080

Community School

Highgate Heights Elementary

Accountability status: Good Standing

600 Highgate Ave

(716) 816-4050

C/W = Citywide

N/H = Neighborhood PK-8

Uniform

9:00am-3:55pm

081 School #81

Accountability status: Good Standing

140 Tacoma Ave

(716) 816-4060 GEN = General Education PK-8

No Uniform

9:00am-3:55pm

082

Early Childhood Center

Accountability status: Comprehensive

Support & Improvement (CSI)

230 Easton Ave

(716) 816-4070 GEN = General Education PK-4

Uniform

9:00am-3:55pm

089

Community

School

Dr. Lydia T. Wright School of Excellence

Accountability status: Good Standing

106 Appenheimer St

(716) 816-4110 GEN = General Education PK-8

Uniform

9:00am-3:55pm

092

Community School

B.U.I.L.D. Community School

Accountability status: Good Standing

340 Fougeron St

(716) 816-4140 GEN = General Education PK-8

Uniform

7:56am-3:05pm

093

Community School

Southside Elementary

Accountability status: Targeted Support & Improvement (TSI))

430 Southside Pkwy

(716) 816-4818 GEN = General Education PK-8

No Uniform

8:00am-2:55pm

094

Community School

West Hertel Elementary

Accountability status: Good Standing 489 Hertel Ave (716) 816-4150

GEN = General Education PK-8 Uniform

8:00am-2:55pm

095 Waterfront Elementary

Accountability status: Good Standing

95 Fourth St

(716) 816-3900 GEN = General Education PK-8

No Uniform

8:00am-2:55pm

097

Community

School

Harvey Austin Elementary

Accountability status: Good Standing

1405 Sycamore St

(716) 816-4460 GEN = General Education PK-8

Uniform

9:00am-3:55pm

099

Stanley Makowski Early Childhood

Center

Accountability status: Good Standing

1095 Jefferson Ave

(716) 816-4180 GEN = General Education PK-4

Uniform

9:00am-3:55pm

156 Frederick Law Olmsted School

Accountability status: Good Standing

319 Suffolk St

(716) 816-4330 GAT – Gifted and Talented* 5-12

No Uniform

8:00am-2:50pm

192

Buffalo Academy for Visual &

Performing Arts

Accountability status: Good Standing

450 Masten Ave

(716) 816-4220

DAN = Dance* MSC = Music (Instrumental./Vocal)*

THT = Theater*

VIS = Visual Arts* CMM=Communication Arts/Media

(grades 9-12 only)

(Differentiated programs are available for

some special education students in special

classes.)

5-12 No Uniform

7:50am-2:45pm

195

City Honors School at Fosdick-Masten

Park

Accountability status: Good Standing

186 E North St (716)816-4230

IBA – International Baccalaureate/

Accel.* 5-9

No Uniform 8:00am-2:50pm

196

Math Science & Technology Preparatory

School @ 39

Accountability status: Comprehensive Support & Improvement (CSI)

487 High Street

(716) 816-3501 GEN = General Education 5-8

Uniform

8:00am-2:55pm

Page 17: 2020-2021 Registration/Application Packet

Page 17 of 18

197

Math, Science, Technology Preparatory

Accountability status: Comprehensive

Support & Improvement (CSI)

646 E Delevan Ave

(716) 816-4500

GEN=General Education

BUS=Business & Entrepreneurship* MCP=Medical Careers Pathway* (leads

to one of the following majors: Health

Information Technology or Health/Nurse Assisting)

(Differentiated programs are available for

some special education students in special

classes.)

9-12 No Uniform

8:00 am-3:10pm

198

Community

School

International Prepatory School

Accountability status: Good Standing 110 14th St (716) 816-4300

GEN=General Education BUS=Business & Entrepreneurship*

MTA=Multilingual Teacher Academy/ Sign Language*

ARD=Architectural & Design*

9-12 No Uniform

7:50 am-3:05pm

206

Community

School

South Park High School

Accountability status: Comprehensive

Support & Improvement (CSI)

150 Southside Pkwy

(716) 816-4828

GEN=General Education AMS=Advanced Manufacturing in Solar

Technology*

BUS= Business & Entrepreneurship* PTF=Personal Training & Fitness*

SPA=Spa Specialty*

FAD=Fashion Arts & Design Studies*

(Differentiated programs are available for

some special education students in special

classes.)

9-12 No Uniform

8:20 am-3:35pm

207

Community

School

Lafayette International High School

Accountability status: Good Standing

370 Lafayette St

(716) 816-4340

CPE=College Preparatory for English (admittance based on: English Language

Learners with 6 years or less in the United

States, including students from Puerto Rico,

who score at the Entering, Emerging or

Transitioning levels of English proficiency)

9-11 No Uniform

8:56 am-4:05pm

208

Community School

Riverside Academy High School

Accountability status: Good Standing

51 Ontario St

(716) 816-4360

Blue Economy:

ECO=Ecology & Conservation* ETO=Eco-Tourism/Entrepreneurship*

HAW=Health & Wellness*

(Differentiated programs are available for

some special education students in special classes.)

9-10 No Uniform

7:55 am-3:10pm

212 Leonardo da Vinci High School

Accountability status: Good Standing

320 Porter Ave

(716) 816-4380

MAA=Media Arts & Animation*

CPR=College Prepatory*

(Differentiated programs are available

for some special education students in special classes)

9-10 No Uniform

7:50 am-3:05pm

301

Burgard High School

Accountability status: Comprehensive

Support & Improvement (CSI)

400 Kensington Ave (716) 816-4450

GEN=General Education

EMT= Exploratory Manufacturing*

Technologies (leads to one of the following majors: Automotive

Technology, Advanced Machine Tool

Technology, or Welding)

9-12 No Uniform

7:55am -3:10pm

302 Emerson School of Hospitality

Accountability status: Good Standing

86 W Chippewa St

(716) 816-3018

HOS-Hospitality/Culinary Arts

(Allergic Food Warning) 9-10

No Uniform

8:15 am-3:30pm

304

Hutchinson Central Technical High

School

Accountability status: Good Standing

256 Elmwood Ave

(716)816-3888

ENG=Engineering*

(Differentiated programs are available for

some special education students in special classes.)

9-10 No Uniform

7:55am-3:10pm

305 McKinley High School

Accountability status: Good Standing

1500 Elmwood Ave

(716) 816-4480

AQU= Aquatic Ecology*

EBT=Exploratory Building Trades* HTC=Horticulture*

PRT=Printing*

UTA=Urban Teacher Academy*

(Differentiated programs are available for

some special education students in special classes.)

9-10 No Uniform

8:20am-3:35pm

309

Community

School

East Community High School

Accountability status: Good Standing 820 Northampton St

Public Service Academy:

FOR=Forensics*

LEG=Legal Professions* PFP=Public Service (Police or Fire)*

9-10 No Uniform

7:50am-3:05pm

355

Buffalo School of Culinary Arts &

Hospitality Management

Accountability status: Good Standing

75 W Huron St

(716) 816-4777

HOS=Hospitality/Culinary Arts*

(Allergic Food Warning) 9-10

No Uniform

8:15 am-3:10pm

Page 18: 2020-2021 Registration/Application Packet

Page 18 of 18

*Please note: Students new to the Buffalo Public School District who are transitioning from a similar “like” program may be eligible

for admission.

363

Lewis J. Bennett High School of

Innovative Technology

Accountability status: Good Standing

2885 Main St

(716) 816-4250

GDD=Graphic Animation & Digital

Design* NAH= Networking & Hardware*

SDP=Software Development &

Programming (Early College Program)*

(Differentiated programs are available for

some special education students in special classes.)

9-10 No Uniform

8:10 am-3:25pm

366

Community

School

Research Laboratory High School for

Bioinformatics & Life Sciences

Accountability status: Good Standing

2885 Main St

(716) 816-4010

LSB=Life Sciences Bioinformatics

Research* 9-12

No Uniform

7:55 am-3:10pm

415

Community School

Middle Early College High School

Accountability status: Good Standing

2885 Main St

(716) 816-4010

MEC=Middle Early College*

9-11

No Uniform

7:55 am-3:10pm