U.S. Department of the Interior BUREAU OF INDIAN EDUCATION-AZNN

Kaibeto Boarding School P.O. Box 1420, Kaibeto, Arizona 86053

Phone: (928) 673-3480 “Committed to excellence in Character, Dine’ Language and

Culture, and Academic Achievement”

Enrollment Process SY 2020-21

June 18, 2020 Parents and Guardians, Enrollment packet for school year 2020-21 is enclosed for your child to begin a new school year at Kaibeto Boarding School. The process is different this year due to safety protocols that will require limited proximity and handling of paper work. Enrollment packet will also be available on the school website https://kaibeto.bie.edu See the schedule below for enrollment intake times for drop off and arrangements with school registrar. Returning Students:

• Packets can be dropped off curb side into a collection box for returning students only • Hard copy of printed 2020 Immunization record (retrieve them from local hospitals) • Completed enrollment forms with updated information • Drop into collection box in front of school

New Students: • will need to make arrangements to deliver original vital documents for copying • Complete all enrollment forms • Original Certificate of Indian Blood, • Original Birth Certificate, and • hard copy of printed 2020 Immunization record, and • legal documents guardianship and parental consent/power of attorney

Any questions and arrangements you can call the registrar at (928) 209-5285 or email nita.salabye@bie.edu . Nita Salabye KBS School Registrar Below is the schedule for document drop off for returning students and arrangements for new students.

TUESDAY WEDNESDAY THURSDAY June 30 10am -2pm July 1 10am-2pm July 2 10am-2pm July 7 10am-2pm July 8 10am-2pm July 9 10am-2pm July 14 10am-2pm July 15 10am-2pm July 16 10am-2pm

SCHOOL YEAR: 2020-2021 NAME OF SCHOOL: KAIBETO BOARDING SCHOOL TYPE: BOARDING SCHOOL FUNDING: BIA OPERATED

1. IDENTIFICATION NAME OF STUDENT (PLEASE PRINT) LAST NAME (PLEASE PRINT) FIRST NAME (PLEASE PRINT) MIDDLE NAME (PLEASE PRINT)

P.O. BOX ADDRESS STREET ADDRESS GRADE

CITY STATE ZIP CODE

PHYSICAL ADDRESS

DATE OF BIRTH PLACE OF BIRTH SEX MALE FEMALE

TRIBAL AFFILIATION DEGREE INDIAN ENROLLMENT NUMBER HOME AGENCY

DOMINANT LANGUAGE SPOKEN IN HOME 1. 2.

DOES YOUR CHILD RECEIVE EITHER OF THE FOLLOWING SERVICES?

GIFTED/TALENTED YES NO EXCEPTIONAL STUDENT SERVICES (ESS) YES NO

2. FAMILY INFORMATION FATHER’S LAST NAME (PLEASE PRINT) FATHER’S FIRST NAME (PLEASE PRINT)

P.O. BOX ADDRESS STREET ADDRESS NAVAJO CHAPTER

CITY STATE ZIP CODE

TRIBAL AFFILIATION DEGREE INDIAN ENROLLMENT NUMBER LIVING DECEASED

OCCUPATION (OPTIONAL) EMPLOYER

HOME PHONE NUMBER WORK PHONE NUMBER CELL PHONE NUMBER

OTHER PHONE NUMBER (SPECIFY)

MOTHER’S LAST NAME (PLEASE PRINT) MOTHER’S FIRST NAME (PLEASE PRINT)

P.O. BOX ADDRESS STREET ADDRESS NAVAJO CHAPTER

CITY STATE ZIP CODE

TRIBAL AFFILIATION DEGREE INDIAN ENROLLMENT NUMBER LIVING DECEASED

OCCUPATION (OPTIONAL) EMPLOYER

HOME PHONE NUMBER WORK PHONE NUMBER CELL PHONE NUMBER

OTHER PHONE NUMBER (SPECIFY)

LEGAL GUARDIAN’S LAST NAME (PLEASE PRINT) LEGAL GUARDIAN’S FIRST NAME (PLEASE PRINT)

P.O. BOX ADDRESS STREET ADDRESS APT. NUMBER

CITY STATE ZIP CODE

TRIBAL AFFILIATION DEGREE INDIAN ENROLLMENT NUMBER LIVING DECEASED

OCCUPATION (OPTIONAL) EMPLOYER

HOME PHONE NUMBER WORK PHONE NUMBER CELL PHONE NUMBER

OTHER PHONE NUMBER (SPECIFY)

OTHER (GROUP HOME, ETC.)

P.O. BOX ADDRESS CITY STATE ZIP CODE

STUDENT LIVES WITH:

HOME PHONE NUMBER WORK PHONE NUMBER CELL PHONE NUMBER

OTHER PHONE NUMBER (SPECIFY)

3. PREVIOUS SCHOOL ATTENDED SCHOOL NAME

ADDRESS

CITY STATE ZIP CODE

DATES ATTENDED GRADES COMPLETED

REASON FOR LEAVING

SCHOOL NAME

ADDRESS

CITY STATE ZIP CODE

DATES ATTENDED GRADES COMPLETED

REASON FOR LEAVING

I am legally responsible for this student and hereby apply for his/her admission to this school. I understand that additional information may be requested by the school before the student is enrolled. ___________________________________________________ ________________________________ Signature of Parent/Legal Guardian/ Adult Student Date Day School Enrollment: Approved Not Approved ___________________________________________________ ________________________________

Signature of the Principal Date

KAIBETO BOARDING SCHOOL P.O BOX 1420

Kaibeto, Az. 86053

CHECKOUT AUTHORIZATION FORM Who is authorized to check your child out of school?

School Year 2020-2021

Student Name: _____________________________________________ Grade: ________ Please print name of Parent(s) or Guardian: Mother/Guardian:_____________________________________ Home#: __________________ Work #:________________________________ Cell #:__________________________________ Father/Guardian:______________________________________ Home #:__________________ Work #:________________________________ Cell #:__________________________________ * Please keep in mind that if the school cannot contact a parent/guardian, this form will be utilized to make contact, especially in cases of emergency. All persons listed must be 25 years or older to checkout minor.

Your child will ONLY be released to those you have listed below. Name Relationship to Child Telephone Number

1.

2.

3.

4.

5. RED FLAG for the following reasons: Check with (X) – Documents must be submitted to the school and will be maintained in your child’s file.

� Social Service Order Temporary Court Order/Protection Order

� Permanent Court Order/Protection Order Other:_____________________________

Name of Person(s) and relationship that is involved: ______________________________________________________ __________________________________________ __________________________ Parent/Guardian Signature Date

Please notify the school of any changes regarding the above information immediately.

United States Department of the Interior

Bureau of Indian Education Kaibeto Boarding School

Post Office Box 1420 Kaibeto, Arizona 86053

(928) 673-3480 - (928) 673-3489 – Fax

CONSENT FOR RELEASE OF STUDENT RECORDS Name of student: DOB: Student formerly attended your school has registered at our school in grade . Transcript Standard test results (AIMS, NWEA, etc.) Cumulative Records Attendance Immunization Current Health Records Withdrawal Form PHLOTE Form/Home Language Survey Other: ____________________________ Purpose Transfer Evaluation Due Process Other (Specify below) .

I, hereby, request and authorize you to release to Kaibeto Boarding School my child’s academic records that would assist him/her in grade placement.

Parent/Guardian Signature: Date: Previous School Attended: Address: City: State: Zip: Phone Number: Fax:

U.S. Department of the Interior BUREAU OF INDIAN EDUCATION-AZNN

Kaibeto Boarding School P.O. Box 1420, Kaibeto, Arizona 86053

Phone: (928) 673-3480 “Committed to excellence in Character, Dine’ Language and

Culture, and Academic Achievement

Informed Consent to Counseling

I, _____________________________ (parent) agree to have my child be counseled by the K-8 School Counselor, Lesina Tsosie, at Kaibeto Boarding School for School Year 2020-2021. I understand that a critical part of the counseling relationship is the establishment and confidential relationship between the counselor and the student. I will honor the counselor/student privilege of confidentiality and know that the counselor will always encourage a line of communication between the student and his/her parent(s), teacher(s), and other stakeholders in the students’ life. I understand that the best interest of the student is the core focus of any interaction between the counselor and student. I also understand that my child will participate in Individual and/or Group Counseling sessions in the areas of Personal, Social, Career, and Academic domains.

I further understand that all of my child’s counseling sessions will remain confidential except when certain legal restrictions arise and confidentiality cannot be maintained. These cases include: any form of child abuse (neglect, physical, and/or sexual), danger to one’s self (suicide), and danger to others (homicide, threat to cause harm, fear or injury to someone else).

I also understand that the counselor may choose to consult with other professionally competent mental health professionals about my child’s case. If consultation occurs, in no way will my child’s personal identification be revealed. If the counselor believes that my child should be referred to an outside agency, she will consult with me. If I not able to be contacted, I agree for a referral to be made on my behalf.

I have read and understood the above statements regarding confidentiality, consultation and counseling. I agree to have my child be counseled by the K-8 School Counselor, Lesina Tsosie. I may contact her at any time to talk with her regarding my child and that I may withdraw this consent at any time through a written letter to the counselor.

Enrolled Student Signature: _______________________ Grade: ____ Date: ________________ Parent or Guardian Signature: ________________________ Date: ________________ Parent or Guardian Signature: ________________________ Date: ________________ Counselor Signature: ______________________________ Date: _______________ Principal Signature: ________________________________ Date: ________________ CC: Student File Health Records

NOTICE OF THE NAVAJO NATION TRUANCY LAW 10 NNC 118, 502, & 503

Student: _______________________________Grade: _______________ Parents: ____________________________________________________ Mailing Address: _____________________________________________ The Arizona State Law and the Navajo Nation Compulsory Law require students to attend school. The law requires the parents/guardian to be responsible for their child’s daily attendance and to notify the school of their child’s non-attendance in a timely manner. The primary responsibility to attend school must be with student and parent/guardian. You are hereby given notice of Navajo Nation Truancy Law regarding the compulsory education which states as follows:

• 10 NNC 118 Student Attendance: A. “Every person who has a Navajo child or Navajo children under his or her care between the ages of 5 and 18 years shall assure the attendance of the child or the children in school. For purpose of this Section, a child shall be five years old only if he or she has a fifth birthday prior to December thirty-first of the school year to which this policy is applied. This policy attends to attendance by children who have not yet graduated from high school. Local school governing boards shall develop programs to improve regular school attendance on compliance with this policy.”

• 10 NNC 502 Compulsory School Attendance- Generally: “Education in a Navajo school shall be compulsory as to children between the ages of 5 and 18 years as prescribed and defined in 10 NNC 118 of the Navajo Education Policies.”

• 10 NNC 503 application of State Law and Navajo Nation Law: “The Navajo Nation Council consent to the application of state compulsory school attendance law to the Indian of the Navajo Nation and their enforcement on Indian lands of the Navajo Nation wherever 10 NNC 188 of the Navajo Education Policies regarding compulsory attendance shall apply to all Navajo minors between the ages of 5 and 18 and to all person having care and custody of such minors who are within the civil or criminal jurisdiction of the Navajo Nation.”

I hereby have read the Compulsory School Attendance notice for the School Year 2019-2020.

___________________________ _________________ Parent/Guardian Signature Date