great schools in a great communitysjschools.org/images/district/socpacket2015a.pdf · please bring...
TRANSCRIPT
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The Board of Education does not discriminate on the basis of race, color, national origin, sex, including sexual orientation or transgender identity, disability, age, religion, height, weight, marital or family status, military status, ancestry, genetic information, or any other legally protected category, (collectively, "Protected Classes"), in its programs and activities, including employment opportunities.
Great Schools in a Great Community
3275 Lincoln Avenue Saint Joseph, Michigan 49085 Phone (269) 926-3100 Fax (269) 429-5042
May 1, 2015
Dear Parent,
We will accept Schools of Choice applications beginning May 11, 2015. All applications and enrollment information must be received or post marked by May 29, 2015 in the Superintendent’s Office, 3275 Lincoln Avenue, St. Joseph, MI 49085. The selection process for these openings will be done by a lottery drawing. All applicants will be notified by June 12, 2015 if their application was selected or not.
Openings available:
Grade Level Minimum Openings Available K 15 1 5 2 2 3 5 4 10 5 10 6 4 7 2 8 2 9 4
10 4 11 4 12 4
Please be sure that all information in the enrollment packet is complete. Applications will not be accepted if any information is incomplete. We do not need proof of residence, however, you will need to take the “Suspension/Expulsion Sign-off Sheet” to your current school and have the building principal complete and sign.
If you have any further questions, you may contact the Superintendent’s Office at 269-926-3101.
Sincerely,
Ann M. Cardon Superintendent of Schools
Ann M. Cardon Superintendent of Schools
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Great Schools in a Great Community
3275 Lincoln Avenue Saint Joseph, Michigan 49085 Phone (269) 926-3100 Fax (269) 429-5042
ST. JOSEPH PUBLIC SCHOOLS SCHOOLS OF CHOICE PROGRAM 2015-2016
Guidelines: The St. Joseph Public Schools is accepting applications for enrollment for those students who do not reside within the St. Joseph Public School boundaries, pursuant to Section 105 and 105C of the State Aid Act, subject to available space. Placement will be made on a lottery basis if applicants exceed available openings. Parent/Legal guardian may identify building preferences; however, assignment will be based on available space. There is no tuition charge for students accepted for enrollment under this program. Students do not need a release from their home district if accepted for enrollment in St. Joseph Public Schools under the Schools of Choice Program. Transportation of students accepted in the Schools of Choice Program will be the responsibility of the parent/guardian. If more students apply for enrollment than there are available slots, preference will first be given to siblings of students currently enrolled in the program based on random draw and then other applicants randomly selected. Once a student is accepted in the program, they may continue for the balance of their K-12 education if there is no break in enrollment including expulsion. If the student leaves and wants to return, they will have to reapply. Directions: 1. Parent/Legal guardian needs to complete the attached forms and sign on the appropriate line. A
separate form must be completed if the parent/legal guardian is requesting participation in the Schools of Choice Program for more than one student in the family.
2. The completed forms MUST BE received or postmarked by Friday, May 29, 2015 in the
Superintendent’s Office, 3275 Lincoln Avenue, St. Joseph, MI 49085. No applications postmarked after May 29, 2015 will be accepted.
3. You will be notified of acceptance in a timely manner; no later than June 12, 2015. 4. Questions regarding the Schools of Choice Program should be directed to the Superintendent’s
office at (269) 926-3101.
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The Board of Education does not discriminate on the basis of race, color, national origin, sex, including sexual orientation or transgender identity, disability, age, religion, height, weight, marital or family status, military status, ancestry, genetic information, or any other legally protected category, (collectively, "Protected Classes"), in its programs and activities, including employment opportunities..
Great Schools in a Great Community
Superintendent’s Office ● 3275 Lincoln Avenue ● St. Joseph, MI 49085 ● (269) 926-3100 ● FAX-(269) 926-3103
REGISTRATION CHECKLIST FOR SCHOOL OF CHOICE STUDENTS
Student’s Name:____________________________________________________________________
2014-2015 Grade:__________ Parent Email:___________________________________________
Date: _____________ Parent’s Home Phone: _____________ Parent Cell:__________________
____ Birth Certificate (CERTIFIED COPY) or alternative (within 30 days)/Custody Paper if applicable ONLY if NOT living with a parent named on the Birth Certificate. ___B1/B2 ____Limited Guardianship ____ Court Placement ____ Guardianship
____ Medical Records ____ Immunization Records ____ Physical Form (Y5/Kdgn only) ____ Hearing Test (Y5/Kdgn only) ____ Vision Test (Y5/Kdgn only)
____ Schools of Choice Application Form ____ Suspension/Expulsion Sign-Off Sheet (From Principal) ____ Enrollment Form ____ Release of Records Form ____ Special Education – SJPS Administration to confirm with previous school if applicable.
If no, parent’s initial:_____ ____ New Student Transfer Information (Athletics – if applicable) ____ Academic Transcript (High School and Middle School only) ____ (High School ONLY) A St. Joseph High School Course Description Book is available online at www.sjschools.org.Please read through this book before your student is scheduled to begin school and note the level, prerequisites, and requirements for some classes as well as other pertinent academic information. The counselor will be happy to answer questions you may have about our academic program. Please bring an unofficial transcript, report cards, and/or exit grades when meeting with a counselor to schedule classes for your high school student. This will assist the counselor in placing your student in the appropriate classes.
Comments:____________________________________________________________________________
OFFICE USE ONLY:
___________________________________ Administrator Signature
____________________________________ Date Records Requested Date Received
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The Board of Education does not discriminate on the basis of race, color, national origin, sex, including sexual orientation or transgender identity, disability, age, religion, height, weight, marital or family status, military status, ancestry, genetic information, or any other legally protected category, (collectively, "Protected Classes"), in its programs and activities, including employment opportunities.
Great Schools in a Great Community
Superintendent’s Office ● 3275 Lincoln Avenue ● St. Joseph, MI 49085 ● (269) 926-3100 ● FAX-(269) 429-5042
IMMUNIZATION REQUIREMENTS
State law requires that each student entering school be current with immunizations on the first day of school. Please provide your child’s immunization record when you complete this enrollment packet. A copy of your child’s record will be made and the original returned to you. Because of changes in the immunization laws, please check to see that your child is up-to-date on all immunizations. Your child will not be allowed to enter school without being current on all immunizations. DPT 4 doses required. If the last dose was not given on or after the 4th birthday, a booster dose is required. Most children will have 5 doses. Tetanus A tetanus booster is required 5 years after initial series is complete. Then every Booster 10 years. Polio 3 doses are required. If the last dose was not given on or after the 4th birthday, a booster dose is required. Most children will have 5 doses. MMR 2 doses are required. Hepatitis B 3 doses are required. Varicella 2 doses of varicella (Var) vaccine or history of chickenpox disease. (Required for all children entering kindergarten, all 6th grade students, and all children changing school district.) HIB 4 doses are required. Required for all children 11-18 years of age who are changing school districts or who are enrolled in 6th grade: +1 dose of meningococcal (MCV4 or MPSV4) vaccine. +1 dose of tetanus/diphtheria/acellular pertussis (Tdap) vaccine (If 5 years have passed since last dose of tetanus/diphtheria vaccine – DtaP, or DT) You are eligible for vaccines at the Health Department if your health insurance doesn’t cover vaccines. You may call the Berrien County Health Department main phone number at 926-7121 for other times and locations in Berrien County. If immunizations are against your belief, please contact the School Nurse at 926-3260.
Health Department Immunization Clinic Berrien County Health Department
769 Pipestone Benton Harbor, MI 49022 Phone: (269) 927-5638
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The Board of Education does not discriminate on the basis of race, color, national origin, sex, including sexual orientation or transgender identity, disability, age, religion, height, weight, marital or family status, military status, ancestry, genetic information, or any other legally protected category, (collectively, "Protected Classes"), in its programs and activities, including employment opportunities.
Great Schools in a Great Community
Superintendent’s Office ● 3275 Lincoln Avenue ● St. Joseph, MI 49085 ● (269) 926-3100 ● FAX-(269) 429-5042
ST. JOSEPH PUBLIC SCHOOLS NON RESIDENT Schools of Choice Application
2015-2016 School Year
APPLICATIONS MUST BE POSTMARKED NO LATER THAN MAY 29, 2015 (Applications MUST BE returned to Sue Patzer, St. Joseph Public Schools, 3275 Lincoln Avenue, St. Joseph, MI 49085)
STUDENT’S NAME__________________________________________________________________________ (Last) (First) (Middle) STREET ADDRESS__________________________________________________________________________ CITY__________________________________ STATE_________________ ZIP CODE_________________ HOME PHONE__________________________ CELL___________________ WORK____________________ [ ] MALE [ ] FEMALE STUDENT’S DATE OF BIRTH ________________________________ PARTICIPATES IN: [ ] BAND [ ] ORCHESTRA PARENT/GUARDIAN________________________________________________________________________ (Last) (First) (Middle) School district student is currently attending________________________________________________________ School district where you currently reside__________________________________________________________ Current grade level______________________ Grade level as of September 2015 _________________________ Do you have other siblings enrolled in the St. Joseph School District now? [ ] Yes (School____________) [ ] No Other siblings applying? [ ] Yes [ ] No If yes, please list: __________________________________ ________________ ___________________ Name Current Grade Grade as of September, 2015 __________________________________________ ____________________ ________________________ Name Current Grade Grade as of September, 2015 __________________________________________ ____________________ ________________________ Name Current Grade Grade as of September, 2015
FOR OFFICE USE ONLY: Date Received:______________________________ Grade:__________ [ ] Approved:________________________________ [ ] Enrollment Denied: ________________________
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The Board of Education does not discriminate on the basis of race, color, national origin, sex, including sexual orientation or transgender identity, disability, age, religion, height, weight, marital or family status, military status, ancestry, genetic information, or any other legally protected category, (collectively, "Protected Classes"), in its programs and activities, including employment opportunities.
Great Schools in a Great Community
Superintendent’s Office ● 3275 Lincoln Avenue ● St. Joseph, MI 49085 ● (269) 926-3100 ● FAX-(269) 429-5042
NOTE: ALL ENROLLMENT PAPERS IN THIS PACKET MUST BE COMPLETE. IF THEY ARE NOT, THE SCHOOL OF CHOICE APPLICATION WILL NOT BE ACCEPTED. NOTE: Acceptance for enrollment shall not be granted or refused based upon religion, race, color, national origin, sex, weight, marital status or athletic ability. Please read and sign: I am applying to have my son/daughter attend St. Joseph Public Schools under the Schools of Choice Program. I have read the guidelines and understand the procedures related to that program. In order to process the student’s application, I give my permission for St. Joseph Public Schools to receive student record information from my student’s current or previous school(s) regarding academic and disciplinary records. This permission is pursuant to the Family Educational Rights and Privacy Act (FERPA). Further, I certify all of the information provided above to be true and accurate, and acknowledge and accept the policies and stipulations of the St. Joseph Public Schools’ Schools of Choice Program. Additionally, I understand that my child’s acceptance into the program is conditional until St. Joseph receives and reviews all of his/her school records. ____________________________________________________________ ___________________________________________ Signature of Parent/Legal Guardian Date Email Address:__________________________________________________________ NOTE: Notification of acceptance will occur in a timely manner but no later than June 12, 2015.
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The Board of Education does not discriminate on the basis of race, color, national origin, sex, including sexual orientation or transgender identity, disability, age, religion, height, weight, marital or family status, military status, ancestry, genetic information, or any other legally protected category, (collectively, "Protected Classes"), in its programs and activities, including employment opportunities.
Great Schools in a Great Community
3275 Lincoln Avenue Saint Joseph, Michigan 49085 Phone (269) 926-3100 Fax (269) 429-5042
Suspension/Expulsion Sign-off Sheet 2015-2016 School Year
RE: Schools of Choice Program
Dear Principal,
This letter is in regard to the student listed below who has applied for the Schools of Choice Program at St. Joseph Public Schools. According to state law, we can deny any student enrollment who has been expelled or suspended (this also means in-school) in the Schools of Choice Program.
Has the student listed below been suspended (out-of-school, in-school, removal from a class for more than 15 minutes) within the previous two school years? [ ] Yes [ ] No. If yes, please describe the incident.
Describe:_____________________________________________________________________
____________________________________________________________________________
Has this student been expelled within the previous two school years? [ ] Yes [ ] No
Student: ___________________________________ Current Grade: ___________________
_______________________________ ______________________________ Print Principal’s Name Principal’s Phone Number
_______________________________ _____________________________ Principal’s Signature Date
Thank you for your assistance.
Sincerely,
Ann M. Cardon Superintendent of Schools
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St. Joseph Public Schools Enrollment Form Please print clearly & fill in all information – Information is to be completed by the Parent/Guardian
FOR OFFICE USE ONLY: ☐ School of Choice Application GRADE: FIRST DAY TO ATTEND SJPS:
STUDENT INFORMATION Last Name (as it appears on Birth Certificate)
First Name (as it appears on Birth Certificate) Middle Name
Student’s Previous Legal Name (if applicable) Gender: Date of Birth: (mm/dd/yyyy) Male ☐ Female ☐
MONTH DAY YEAR
Is there a current Order of Protection or No Contact Order which concerns this student? YES ☐ NO ☐ CURRENT RESIDENTIAL ADDRESS
Street Number Street Name Apt # City State Zip Code Is this temporary housing or shelter?
YES ☐ NO ☐
MAILING ADDRESS (If different than listed above) Street Number Street Name Apt # City State Zip Code
OTHER STUDENT INFORMATION Primary Home Phone Number Is the primary phone a cell phone? Is the home phone unlisted?
( ) YES ☐ NO ☐ YES ☐ NO ☐ Student Cell Phone Number: Has the student ever attended St. Joseph Public Schools?
( ) YES ☐ NO ☐
Does the student have an IEP? Does the student receive any 504 services? YES ☐ NO ☐ YES ☐ NO ☐ Last School attended
School’s Address Previous School District attended Grade Entering
PARENT/GUARDIAN INFORMATION This student will be released to the person(s) listed as parent/guardian. All mailings will go to the parent/guardian with whom the student lives.
First & Last Name of the Parent(s)/Guardian with Whom The Student Lives:
Relationship to the Student
Primary Home Phone Number ( )
Cell Phone Number ( )
Work Phone Number ( )
☐ Day ☐ Evening
Employer’s Name Parent/guardian’s primary language Does this person speak English? YES ☐ NO ☐
Do you require information in Spanish? Are you a seasonal/agricultural worker? Are you an active military service member? YES ☐ NO ☐ YES ☐ NO ☐ YES ☐ NO ☐
Email Address:
First & Last Name of 2nd Parent/Guardian:
Relationship to the Student
Residential Address (if different from student) Street Number Street Name Apt # City State Zip Code
Primary Home Phone Number ( )
Cell Phone Number ( )
Work Phone Number ( )
☐ Day ☐ Evening
Employer’s Name 2nd Parent/Guardian’s Primary Language spoken in the home: Does this person speak English? YES ☐ NO ☐
Do you require information in Spanish? Are you a seasonal/agricultural worker? Are you an active military service member? YES ☐ NO ☐ YES ☐ NO ☐ YES ☐ NO ☐
Email Address:
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ETHNICITY (This is a two-‐part question required by the Federal Government)
1. Is the student Hispanic or Latino? YES ☐ NO ☐ 2. What is the student’s ethnicity/race? (Select all that apply)
☐ American Indian or Alaska Native (origins in any of the native peoples of North, South or Central American, or tribal affiliation) ☐ Asian (Origins in any of the native peoples of the Far East, Southeast Asia, or the Indian subcontinent) ☐ Black or African American (Origins in any of the black racial groups of Africa) ☐ Hispanic/Latino ☐ Native Hawaiian or Other Pacific Islander (Origins in any of the native peoples of a Pacific Polynesian island) ☐ White (Origins in any of the native peoples of Europe, North Africa, Russia, or the Middle East)
Student’s Country of Birth Does the student speak English? What is the primary language spoken in the home? YES ☐ NO ☐
EMERGENCY CONTACTS Must be different from parent/guardian information; Must be 18 years of age or older; Student will be
released to any person listed below if parent/guardian is unreachable in an emergency. Please list at least 2 contacts other than parent/guardian.
1. First & Last Name
Relationship to the Student
Primary Home Phone Number ( )
Secondary Phone Number ( )
Work Phone (If applicable) ( )
☐ Day ☐ Evening
2. First & Last Name
Relationship to the Student
Primary Home Phone Number ( )
Secondary Phone Number ( )
Work Phone (If applicable) ( )
☐ Day ☐ Evening
3. First & Last Name
Relationship to the Student
Primary Home Phone Number ( )
Secondary Phone Number ( )
Work Phone (If applicable) ( )
☐ Day ☐ Evening
CONSENTS TO RELEASE INFORMATION Please indicate your consent to the entire statement by checking the YES or NO box. These consents will be in effect for the current school year. Please read the description of the student directory information provided in the district student handbook. This directory information will be released without prior parental
consent in compliance with FERPA (Family Educational Rights & Privacy Act).
A. My child may be photographed, video recorded, interviewed and/or televised for school-‐related communications including the school website and/or school social media.
YES ☐ NO ☐ B. My child may be photographed, video recorded, interviewed and/or televised for district-‐related
communications including the district website and/or district social media. YES ☐ NO ☐
C. My child may be photographed, video recorded, interviewed and/or televised by Non-‐SJPS Media (such as a newspaper/television)
YES ☐ NO ☐ D. District Health Care Aide, RN or a trained staff may administer medications and have access to my
child’s school registration and health records. YES ☐ NO ☐
E. The district staff may transport my child home or to the caregiver. YES ☐ NO ☐ F. The district staff may transport my child, if necessary, to health evaluations or screenings. YES ☐ NO ☐ G. The school or district may send automated phone calls to the primary home phone indicated on this
form. This includes any cell phone listed as a primary home phone (emergency calls or attendance calls can not be excluded).
YES ☐ NO ☐
H. The school or district may send text messages to the parents’ cell phone listed on this form. This includes any cell phone listed a s primary home phone (standard texting fee may apply).
YES ☐ NO ☐
I. My high school child’s information can be released to the military. YES ☐ NO ☐ J. Military YES ☐ NO ☐
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SIBLINGS Please list siblings that are registered in the St. Joseph Public School District & the building they are enrolling.
NAME AGE School/Building Enrolled
Public Act 328 Public Act 328 (effective January, 1, 1995) requires public school districts to expel any student who possesses a dangerous weapon on a weapon-‐free school zone or commits either arson or rape in a school building or on school property (including school buses and/or other school transportation). A dangerous weapon is defined as “a fireman, dagger, dirk, stiletto, knife with blade with blade over three (3) inches in length, pocket knife opened by a mechanical device, iron bar, or brass knuckles or other devices designed to or likely to inflict bodily harm, including, but not limited to, air guns, and explosive devices.” Check One:
☐ Has not been expelled from another school. ☐ Has been expelled from another school (or has expulsion charges pending). ☐ Is currently under suspension from another school.
Parent/Guardian Signature Parent Name (Please Print) Date
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The Board of Education does not discriminate on the basis of race, color, national origin, sex, including sexual orientation or transgender identity, disability, age, religion, height, weight, marital or family status, military status, ancestry, genetic information, or any other legally protected category, (collectively, "Protected Classes"), in its programs and activities, including employment opportunities.
Great Schools in a Great Community
St. Joseph Public Schools ● 3275 Lincoln Avenue ● St. Joseph, MI 49085 ● (269) 926-3100 ● FAX-(269) 429-5042
AUTHORIZATION TO RELEASE SCHOOL RECORDS STUDENT’S NAME______________________________________________________________ DATE OF BIRTH________________ PRESENTLY ENTERING GRADE____________________ PREVIOUS SCHOOL____________________________________________________________ SCHOOL ADDRESS_____________________________________________________________ CITY/STATE/ZIP CODE__________________________________________________________ PHONE NUMBER_________________________ FAX NUMBER_________________________ Is hereby authorized to make the following information available to St. Joseph Public Schools.
• All School Records (including special education records) • Health and Immunization Records • Student Discipline Records • Semester Grades and Withdrawal Grades
Please forward information to the following: Y5s/KINDERGARTEN/GRADES 1-5: _____Brown Elementary, 2027 Brown School Road, St. Joseph, MI 49085 _____E. P. Clarke Elementary, 515 East Glenlord Road, St. Joseph, MI 49085 _____Lincoln Elementary, 1102 Orchard Avenue, St. Joseph, MI 49085 GRADES 6-8: GRADES 9-12: Upton Middle School St. Joseph High School 800 Maiden Lane 2521 Stadium Drive St. Joseph, MI 49085 St. Joseph, MI 49085 (269) 926-3400 (269) 926-3200 Fax: (269) 926-3403 Fax: (269) 926-3203 _____________________________________ _________________________________ Signature of Parent or Guardian Date
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NEW STUDENT – TRANSFER INFORMATION FORM 2014-15
Yes � No � I am interested in participating in athletics. To be completed by new students, parents and former school. This form is intended to assist schools in compiling infor-mation to determine eligibility under MHSAA Regulations for students who change schools after starting the 9th grade. Provide copies in new student enrollment material. Request the form be submitted as soon as possible after enrollment to the athletic director for evaluation. The AD may then contact the MHSAA for assistance. Consult Int. 65 and 77 to assist in determining if residential changes are full and complete. Int. 37 states two current and complete documents are prerequisites for participation: Physical Exam/Consent Form and official school record (transcript) since first enrolling in the 9th grade of any school. NAME_______________________________________ GRADE_________ BIRTHDATE____/____/____ STUDENTS NAME ________________________ GRADE ________________ BIRTHDATE ___/___/___
PHONE: _____________________ EMAIL: _____________________________________________
CURRENT (NEW) ADDRESS ____________________ CITY__________________ STATE_____ZIP______
DATE OF RESIDENCE CHANGE INTO CURRENT (NEW) ADDRESS _______________________________
CURRENT (NEW) PUBLIC SCHOOL DISTRICT IN WHICH YOU RESIDE ____________________________
OLD HOME ADDRESS _________________________ CITY_________________ STATE______ ZIP _____
FORMER RESIDENCE (Check all that apply) __ Vacant __ Sold __ Rented ___ All Belongings Moved? Y N
OLD PUBLIC SCHOOL DISTRICT OF RESIDENCE _____________________________________________
PARENT(S) or GUARDIAN(S) _________________________________________ Phone: ______________ 1. The last school the student attended: _______________________________________________________ 2. While enrolled at former school, the student lived with __________________________________________ (List all people: Parents, guardians, siblings, or others) YES NO The student lived with the above for at least 30 days during the most recent previous academic term. 3. The student now lives with ______________________________________________________________ (List all people: Parents, guardians, siblings, or others) CIRCLE THE CORRECT ANSWER: 4. 8 9 10 11 12 Circle the highest grade in which the student was enrolled at any previous school.
5. YES NO The school previously attended is a nonpublic, private or parochial school.
6. YES NO The student is a “Ward of the Court/State” and was placed in this school district by court order.
7. YES NO The student is an international student enrolling from a foreign country Circle VISA: F-1 J-1
7a. YES NO The student is from an MHSAA Approved International Student Program (AISP):
Name the Program: ____________________ AISP Program is listed on MHSAA.com Y N
8. YES NO The student’s previous school has been closed, dissolved or reorganized (See Int. 64 & 90)
9. YES NO The student’s parents are divorced. If divorced, give exact decree date: Month______ Year_____
10. YES NO The student is 18 or under; or the 19th birthday is on or after Sept. 1 of this school year.
11. YES NO Last year, the student was a student at a boarding school, or while enrolled out of state attended a sports academy. 12. YES NO The student is 18 and moved into this district without his or her parents.
13. YES NO The student is a 9th or 10th grader and has not played in a scrimmage or game in any MHSAA sport.
14. YES NO The student participated in a cooperative program involving his/her previous school and our school.
15. YES NO The student wishes to discuss her/her situation with the athletic director. OVER
THIS Number of classes for which credit has been given in the previous academic term: ____ SECTION Number of potential classes for a full-time student in our high school: _____ COMPLETED Official enrollment date (in school books & attending one or more classes) ___/_____/_____ BY SCHOOL Number of semester’s ____ and/or trimesters ____ in grades 9-12 completed to date. & STUDENT In what school year did the student end the 8th grade (and begin grade 9)? 20__ - 20__.
Has the student repeated any grade 9-12? Yes ___ No ___
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VERIFICATION OF ATHLETIC RELATED TRANSFER REGULATION FOR STUDENTS SITTING OUT WHO DO NOT MEET AN EXCEPTION TO THE PERIOD OF INELIGIBILITY (Reg. I, Section 9 [F])
“Links to open gyms, former coach/personal trainer (school or non-school sports & summer teams).”
16. List the high school sports the student participated in (game/meet or scrimmage) since first enrolling in the 9th grade at the previous school ________________ ____________________ ___________________
17. List the sports in which the student desires to participate in during the next 12 months at new school: ________________ ________________ _____________________ ___________________
Today’s Date: In the past 12 months?
18. YES NO The student has attended an open gym at our high school. 19. YES NO The student has competed or practiced in a sport that involved coaching by any member of
our school’s coaching staff (current or incoming) in any summer activities or non-school sports such as AAU basketball. If yes, indicate the staff member and nature of the activity:
________________________________________________________________________ 20. YES NO The student has had involvement with any member of our school’s coaching staff (current or
incoming) who provided individual or team instruction in sports or as a conditioner, per-sonal trainer or coach whether paid or volunteer. If yes, indicate the staff member and the activity: _______________________________________________________________________
21. YES NO While at the former high school the student was coached by any member of our high
school’s coaching staff (current or incoming). If yes, indicate the name of the coach and sport: ________________________________________________________________________
RECOMMENDED VERIFICATION & COMMUNICATION BETWEEN SCHOOLS
By my signature below I state that the above is true and accurate. I also understand that contests the student participates in may be forfeited to opponents if the information submitted is not accurate: _________________________ ___________ _________________________ __________ Student Date Parent Date ________________________ _______________ _________________ ___________________ New School Athletic Director Date School email or fax
To Former School Athletic Director: Please sign and return to AD at the student’s new school Exchange this form between athletic directors for students who wish to play the same sport as played previously. The former school athletic director indicates that to the best of their knowledge the above is true and accurate: ____________________________ _________ Form Returned to New School: _____________ Former School Athletic Director Date Date Notes if former AD declines to sign: ________________________________________________________________________________________ ________________________________________________________________________________________
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This page for internal school use.
Do not send any page of this form to the MHSAA. Return the completed form to the School Athletic Director who should compete the following:
The eligibility status of _____________________________ at ________________________________ High School is checked below. ____ This student is IMMEDIATELY ELIGIBLE to participate in interscholastic athletics. ____ This student will be eligible upon completion and processing of the Educational Transfer Form. ____ There is a question about the eligibility of this student and he/she may not participate in interscholastic athletics until written permission is given by the school and the MHSAA. ____ This student is NOT ELIGIBLE to participate in interscholastic athletics. ____ This student may be ELIGIBLE effective ___/____/____
SIGNED: _____________________________________ DATE:_____________ Athletic Director SIGNED: _____________________________________ DATE:_____________ Principal
Assistance in Applying the MHSAA Transfer Rule and Interpretations
Page 1 and 2 of this form is based upon the following MHSAA Regulations, Sections and Interpretations. Admin-istrators should consult the MHSAA Handbook and then, if necessary, the MHSAA staff to assist in processing a new student transfer. The only interpretations that are official are those received in writing. This boxed information is intended to provide evidence to address Regulation I, Section 2 (age eligibility), Section 4 (max-imum enrollment), Section 7 (previous academic term record), and Section 9(A-F) (transfer student). A transfer student must be enrolled prior to Oct 1 to participate in fall MHSAA tournaments, Feb 1 winter tournaments or May 1 for spring tournaments. See Reg. I, Section 9 [G]. The CAPITALIZED INFORMATION on residence relates to Regulation I, Section 9 exceptions regarding residence change “from one public school district to a different pubic school district.” Exceptions: 1, 2, 3, 4, 5, 8, & 12 and Int. 90. Line 1: Indicates type of school: public, nonpublic or charter school. Lines 2/3: Regulation 1, Section 9(A), Exception 1, (30 days) Interpretations 65 and 90. Line 4: Determine grade level. Regulation 1, Section 9(A), Exceptions 10 and 11. Line 5: Verification of line 1 and Interpretation # 62 (school of residency). Line 6: Regulation I, Section 9(A), Exception 3. Line 7: Regulation 1, Section 9(A), Exception 4. J-1 or F -1 Visa International Students See Interpretations 83-88 and
MHSAA.com for Approved International Student Program (AISP) listing. Line 8: Regulation I, Section 9(A), Exception 6, (also see Interpretations 65, and 90) Line 9: Regulation I, Section 9(A), Exception 8 (allowed one time. Use updated Educ. Transfer Form (MHSAA.com) Student moving between parents who never married see Interpretation 92 and include documentation. Line 10: Regulation I, Section 2. Line 11: Regulation I, Section 9(A), Exception 2 (Int. 62, 63) or Exception 1 (Int.67 - out-of-state sports academy). Line 12: Regulation I, Section 9(A), Exception 12 (allowed one time. See Educational Transfer Form). Line 13: Regulation I, Section 9(B). Subvarsity for 9th-or 10th-grade students with no athletic participation. Line 14: Regulation I, Section 9(C). Former school must concur and student must have participated in the co-op. Line 15: Acknowledges that the student or parents need to discuss the matter of eligibility further. Lines 16 -21 Regulation I, Section 9 (F) Checks links associated with the Athletic Related Transfer Regulation resulting in
a period of 180 schedule school days of ineligibility for students who do not meet one of the stated excep-tions.
Revised May 15, 2014
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