Allamuchy Township School District Registration

ChecklistNew and Transfer Students

Registration Form

Transfer Card (if coming from another school district)

New Student Health History/Immunizations

Student Physical Examination

Birth Certificate

Custody Papers (where applicable)

Verification of Domicile/Residence

Allamuchy School District will accept the following documents as proof of residency:

CATEGORY A (1 document required)

DeedSigned Current Rental LeaseAffidavit of LandlordProperty Tax BillMortgage StatementClosing Statement for the proof of residency

CATEGORY B (2 documents required) Current w/in 45 days

Utility Bill (water,gas, electric) Home/Apartment Insurance Bank Statement Pay Stub Water/Sewer Bill1st Class Letter from Federal or State Agency

If the applicant is unable to provide the documentation listed in Category A and/or Category B, the applicant may request consideration of additional documents showing proof of residency. Requests for consideration should be directed to the Business Administrator inwriting. This review may include other evidence of property ownership, tenancy, orresidency; personal attachment to a particular location; court or agency placements or directives; expenditures demonstrating personal attachment to a particular location or to support the student; circumstances demonstrating family or economic hardship, ortemporary residency; or any other business record or document issued by a governmental entity. The District will consider the totality of the information and documentationpresented as proof of residency and will not deny enrollment based upon the failure toprovide a particular form or subset of documents without regard to the other evidence presented.

Legal References:

N.J.S.A. 18A:38-1 et seq.N.J.A.C. 6A:22-1.1 et seq

Please submit completed paperwork and all required documents to:

Pat Gardiner: pgardiner@aes.k12.nj.us or mail to Allamuchy Twp Schools c/o Pat Gardiner

PO Box J Allamuchy NJ 07820

Allamuchy Township School District New Student Registration Form Please submit completed paperwork and all required documents to:

Pat Gardiner: pgardiner@aes.k12.nj.us or mail to Allamuchy Twp Schools c/o Pat Gardiner PO Box J Allamuchy NJ 07820

DIRECTIONS TO PARENT/GUARDIAN; The questions on this form must be administered at the time of student enrollment. Some responses are optional to protect the privacy of student or family; however, the parent or guardian should understand that his/her responses to these questions will be of great help to the district and the state in planning a program that meets the unique needs of his/her child. If the parent or guardian declines to respond to a question, leave the item blank.

Office Use Only

Student ID# __________ _ Grade ---------

Homeroom ·------------

Bus Route ____________ _ CST Code _____ _ Entry Date __________ _

PARENT INFORMATION: PARENTE-MAIL ADDRESS ________________TODAY'S DATE:__ STUDENT INFORMATION:

1. Name of Child: Last First Middle ----------- ----------- ---------

2. Gender of Child: Male Female Other3. Age of Child: ____ Date of Birth ___________ Proof of Age __________4. Child'sCityofBirth ______________ State _______ Country________ _ 5, Please provide the permanent or home address of student:Address

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City __ �---,--------- State ______ _ 6. Home Telephone Number

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7. Family Status --,-,,-c--,----,-----,--,---------------------------8. Student Resides with (Please check one):

o Mother only Mother & Father o Father onlyD Father & Stepmother □ Mother & Stepfather

9. Mother's (Guardian's) Information□ Guardian

D Custodial Parent D Non-Custodial Parent WITH access to student records

□ Other --------

□ Non-Custodial Parent NO access to student records (Court Order must be provided)Mother's/Guardian's Name _____________ Maiden Name ___________ _ Mother's Physical Address (if different than student) Street_�-�---�------,--City __________ State __ Zip ____ _ Mother's/Guardian's Telephone Number (if different than student) _______________ _ Mother's Birthplace--�---�------ Mother's Occupation�------------Mother's/Guardian's Employer & Address _______________________ _ Mother's Guardian's Work Phone Number __________ Cell Number ________ _ Mother's Education Cell Phone Carrier

---------------- ----------

E-mail Address ------------------------------------

10. Father's/Guardian's InformationD Custodial Parent D Non-Custodial Parent WITH access to student records

D Non-Custodial Parent NO access to student records (Court Order must be provided)Father's/Guardian's Name

���-

-,---

-,-,-,--

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-

Father's Physical Address (if different than student) Street �-----,�-----,-�--�-�=�City __ -,-----, ______ State __ Zip ____ _ Father's/Guardian's Telephone Number (if different than student)

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Father's Birthplace __ �-�-� ______ Father's Occupation. ____________ _Father's/Guardian's Employer & Address

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Fa the r's Guardian's Work Phone Number ___________ Cell Number _________ _ Father's Education_________________ Cell Phone Carrier ________ _ E-mail Address

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11. Family Physician's Name --------------------------------

Address --------------------------------------

Telephone Number _______________________________ _12. Brother's Older/Younger (Name and Birth Date) _____________________ _

Sister's Older/Younger (Name and Birth Date) ______________________ _

13. Child D Left Handed D Right Handed14. Race/Ethnicity of Child: Place an "X" in one or more boxes to indicate what you consider the child to be.

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 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 sub continent including Cambodia, China, India, Japan, Malaysia, Pakistan, the Philippine Islands, Thailand or Vietnam.

D Black or African American -A person having origins in any of the black racial groups of Africa.

D Spanish/Hispanic/Latino -A person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin, regardless of race

D Native Hawaiian or Other Pacific Islander -A person having origin in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands.

D White - A person having origins in any of the original peoples of Europe, Middle East or N01th Africa. 15. The National or Ethnic subgroup which a child or parent/guardian most clearly identifies (Optional). A representative

sample of subgroups in New Jersey are listed below. Place an "X" in the box for one or more subgroups (up to 3selections possible.)

o Bosnia o India o Mexicoo China o Ireland o NigeriaD Columbia D Italy D Pakistano Dominican Republic o Japan o Philippineso Egypt o Korea o Poland□Germany o Lebanon o Puerto Ricoo Guam o Liberia o Russia

o Salvadoro Samoao Taiwano United States (America)D Other:o Other:

16. Language of Child. The language or dialect first learned by an individual or first used by the Parent/Guardian with achild. This item is often referred to as the first language spoken. A representative sample of language in New Jerseyis listed below. Place an "X" in the box to indicate the native language of the child.

o Arabic o Fulfulde, Nigerian o Punjabi, Easterno Armenian □German o Punjabi, Westerno Chamorro o Haitian, Creole Frencho Chinese, Mandarin o Hindi o Pashto, N01therno Japanese o Pashto, Southern o Teluguo Korean o Polish o Urduo Kurdish o Sindhi o Other:

o Singhaleseo Somalio Spanisho Chinese, CantoneseD Englisho French

17. Is English understood/spoken by parent/guardian/person enrolling student? o Yes o No18. Language most frequently spoken at home _________________________ _19. Is the student eligible for migrant education services? A "migratory child" means a child who is, or whose parent or

spouse is, a migratory agricultural worker, including a dairy worker or migratory fisher, and who, in the preceding 36months, in order to obtain or accompany such parent or spouse, in order to obtain temporary or seasonal employmentin agricultural or fishing work, has moved from one school district to another or resides in a school district of morethan 15,0000 square miles and migrates a distance of20 miles or more to temporary residence to engage in a fishingactivity. o Yes o No

20. Is the student homeless? A student shall be considered homeless if any of the following conditions apply: Resides ina supervised publicly or privately operated shelter designed to provide temporary living accommodations; Resides inan institution that provides a temporary residence for individuals intended to be institutionalized; Resides in a publicor private place uot designed for or ordinarily used as a regular sleeping accommodation for human beings; Lives witha parent in a domestic violence shelter; A runaway living in a shelter; A sick or abandoned child residing in a hospitalwho would otherwise be released if he/she had a permanent residence; The child of a homeless family which is, out ofnecessity, living with relatives or friends. The child of a migrant family that lacks adequate housing; Finally, a child oryouth shall be considered homeless when a disputer occurs regarding the determination of homelessness.

o Yes □ No21. Does the student qualify to receive federal support as an immigrant? An immigrant is a student who is 3 to 21 and

was NOT born in the U.S. and has not been attending one or more schools in any one or more states for more than three full academic years. □ Yes □ No

22. Are you enrolling iu this school under the regulations of the Every Student Succeeds Act option?□ Yes □ No

23. If you answered YES to the above questions, please identify the reason from the list below.□ Unsafe School Choice Option (USCO)-Provision1:Persistently dangerous School□ USCO -Provision II: Victim of Violent Crimes Offenses □ USCO - Miscellaneous Provisions