NEW STUDENT ENROLLMENT FORM

Name: Grade:

Previous School District: Previous School Phone:

*Please mark “yes” on the following areas that apply:

Does your child receive services for? Concerns in any of these areas?

Special Education Attendance

Title 1/LAP Behavior

Bilingual Retention

Reading Recommendation for Testing

Math

Speech

Physical / Occupational Therapy

This information will help us in placing your child and assist in determining

the need to send for other necessary information from the previous school.

Sedro-Woolley School District #101 Date _________________

STUDENT REGISTRATION/ENROLLMENT FORM Evergreen Elementary School 1007 McGarigle Road Sedro-Woolley Wa 98284

360-855-3545

STUDENT NAME: Legal Last Name Legal First Name Legal Middle Name

Also

known as:

BIRTHDATE (Month/Day/Year)

GENDER

(M/F)

BIRTHPLACE: City State Country County GRADE

LEVEL

ETHNICITY / RACE INFORMATION

PLEASE SEE

ADDITIONAL PAGE

PRIMARY LANGUAGE PLEASE

SEE ADDITIONAL PAGE

ACTIVE MILITARY FAMILY Yes

No

CUSTODY OF STUDENT Joint Not Applicable PHYSICIAN/PHONE

___________________________________________________

PRIMARY HOUSEHOLD (parent/guardian where student resides)

Parent Name (Last, First)

RELATIONSHIP

TO STUDENT

HOME

PHONE

( )

WORK

PHONE

( )

CELL

PHONE

( )

EMPLOYER NAME FOSTER CARE

Yes

No

Parent Name (Last, First) RELATIONSHIP TO STUDENT

HOME

PHONE

( )

WORK

PHONE

( )

CELL

PHONE

( ) EMPLOYER NAME

RESIDENT

ADDRESS

Street/Apt # Please check if change of address from previous year City State ZIP

MAILING

ADDRESS

P/O Box Number or Street/Apt# (if different from above) City State ZIP

EMAIL 1: EMAIL 2:

SECOND HOUSEHOLD (non-custodial parent not residing with child)

Last Name First Name

RELATIONSHIP

TO STUDENT HOME

PHONE

( )

WORK

PHONE

( )

CELL

PHONE

( )

Last Name First Name

RELATIONSHIP

TO STUDENT HOME

PHONE

( )

WORK

PHONE

( )

CELL

PHONE

( )

SECOND HOUSEHOLD ADDRESS (Street/PO Box, City, State, ZIP)

SCHOOL PREVIOUSLY ATTENDED

SCHOOL DISTRICT/LOCATION PREVIOUSLY ATTENDED

HAS STUDENT EVER ATTENDED SCHOOL IN THE SEDRO-WOOLLEY SCHOOL DISTRICT? Yes No IF YES, NAME OF SCHOOL ATTENDED

DATE ATTENDED (Month/Year)

HAS THE STUDENT EVER BEEN SUSPENDED FOR A WEAPONS VIOLATION? Yes No Date: _________________

IS THERE A RESTRAINING ORDER IN EFFECT? Yes No (If yes, legal papers must be on file with the school for enforcement) Restraining order is against: Mother Father Other

HAS YOUR CHILD EVER QUALIFIED FOR OR BEEN ENROLLED IN A SPECIAL ED PROGRAM? Yes No

HAS YOUR CHILD EVER QUALIFIED FOR OR HAD A 504 PLAN? Yes No

HAS YOUR CHILD EVER PARTICPATED IN: Title LAP Gifted ELL Other _________

HAS YOUR CHILD EVER BEEN

RETAINED? Yes No

If yes, at what grade

level(s)____________________

DOES STUDENT ATTEND CHILD CARE?

Before school After school Before and after school

CHILD CARE PROVIDER Name Address Phone Number

ADDITIONAL CHILD CARE ARRANGEMENTS (Please provide information to school in writing)

PLEASE LIST OTHER SIBLINGS ATTENDING IN THE SEDRO-WOOLLEY SCHOOL DISTRICT

Last Name First Name School Grade

When injury, illness or other non-emergency situations occur involving your child, we want to be able to quickly reach families or other

responsible adults. In the event we cannot reach a parent/guardian, please list persons you trust who are available during the day to provide

care for your child.

FIRST CONTACT (other than parent/guardian)

Last Name First Name

RELATIONSHIP TO CHILD HOME PHONE

( )

WORK PHONE

( )

CELL PHONE

( )

FIRST CONTACT ADDRESS Street City, State, ZIP

SECOND CONTACT (other than parent/guardian)

Last Name First Name

RELATIONSHIP TO CHILD HOME PHONE

( )

WORK PHONE

( )

CELL PHONE

( )

SECOND CONTACT ADDRESS Street City, State, ZIP

THIRD CONTACT (other than parent/guardian)

Last Name First Name

RELATIONSHIP TO CHILD HOME PHONE

( )

WORK PHONE

( )

CELL PHONE

( )

THIRD CONTACT ADDRESS Street City, State, ZIP

STUDENT RELEASE AUTHORIZATION: In the event that the school is unable to contact the parent/guardian, I authorize that my

child may be released to the person(s) listed above.

Legal Parent/Guardian Signature ________________________________________________ Date _____________________

EMERGENCY TREATMENT AUTHORIZATION: I, the undersigned, do hereby authorize officials of the Sedro-Woolley

School District to contact directly the persons named on this registration form, and do authorize the named physicians to render such

treatment as may be deemed necessary in an emergency, for the health of said child. In the event physicians, other persons named on this

document, or parents cannot be contacted, the school officials are hereby authorized to take whatever action is deemed necessary in their

judgment, for the health of said child. I will not hold the school district financially responsible for the emergency care and/or transportation

for said child.

Legal Parent/Guardian Signature ________________________________________________ Date _____________________

DIRECTORY INFORMATION: Certain information, known as “Directory Information”, is defined by the Federal Family Rights and

Privacy Act and may be released about your child unless you request, in writing, that such information not be released. We do not release

any “Directory Information” for commercial purposes or for other purposes not related to the conduct of school business.

RELEASE DIRECTORY INFORMATION Yes No Date ___________________________

Occasionally, photographs may be taken of students for use in the news media or in district-produced publications.

CONSENT FOR STUDENT’S PICTURE/VIDEO TO BE TAKEN FOR RELEASE Yes No Date ___________________________

VERIFICATION: The information provided on this form is true and accurate as of this date. I understand that falsification of an address

or the use of any other fraudulent means to achieve an enrollment or assignment shall be cause for revocation of the student’s enrollment

and assignment to the school serving the home attendance area. It is the responsibility of the parent/guardian to notify the school of a

change of address or telephone number in person or in writing.

Legal Parent/Guardian Signature ________________________________________________ Date _____________________

Revised 02/14

SPECIAL INSTRUCTIONS REGARDING RELIGIOUS BELIEFS (Please provide information to school in writing)

FECHA _________________

FORMA DE MATRICULACIÓN / REGISTRO PARA EL ESTUDIANTE

DISTRITO ESCOLAR de SEDRO-WOOLLEY, WA – 360/855-3500

NO ESCRIBA EN LAS ÁREAS SOMBREADAS – PARA EL USO DE LA OFICINA ÚNICAMENTE STUDENT SCHOOL

NUMBER

SCHOOL ENTRY DATE MEDICAL ALERT HOMEROOM # LOCKER # BUS ROUTE

AM PM

NOMBRE DEL ESTUDIANTE: Apellido Legal Primer Nombre Legal Segundo Nombre Legal

Conocido como:

CUMPLEAÑOS(Mes/Día/Año)

SEXO

(M/F)

LUGAR DE NACIMIENTO Ciudad Estado País AÑO ESCOLAR

CÓDIGO ÉTNICO (marque uno)

A-Asiático/ Pacífico Islandés I- Indio Americano/ Nativo de Alaska

B-Negro de origen no Hispano W-Blanco, de origen no Hispano

H-Hispano

IDIOMA HABLADO EN CASA

Inglés Español

Otro ______________________

FAMILIA ACTIVO EN EL EJERCITO

SÍ

NO

CUSTODIA DEL ESTUDIANTE Unida No Aplica Doctor / Teléfono _________________________________________________

PRIMER HOGAR - Padre / Guardián de Familia (que vive con el estudiante)

Apellido Nombre

COMPAÑÍA DONDE TRABAJA

RELACIÓN CON EL ESTUDIANTE

Teléfono De

Casa

( )

Teléfono Del

Trabajo

( )

Teléfono

Celular

( )

Apellido Nombre

COMPAÑÍA DONDE TRABAJA

RELACIÓN CON EL

ESTUDIANTE Teléfono De

Casa

( )

Teléfono Del

Trabajo

( )

Teléfono

Celular

( )

Dirección

Del Hogar

Calle /Dpto. # Ciudad Estado CP

Correspond-

encia ( si es

diferente de

arriba)

Caja Postal o Calle /Dpto # Ciudad Estado CP

SEGUNDO HOGAR ( el padre que no vive con el estudiante)

Apellido Nombre

RELACIÓN CON EL

ESTUDIANTE Teléfono De

Casa

( )

Teléfono

Del Trabajo

( )

Teléfono

Celular

( )

Apellido Nombre RELACIÓN CON EL

ESTUDIANTE Teléfono De

Casa

( )

Teléfono

Del Trabajo

( )

Teléfono

Celular

( )

Dirección del Segundo Hogar (Calle /Caja Postal, Ciudad, Estado, CP)

ESCUELA PREVIA A LA QUE ASISTIÓ

DISTRITO ESCOLAR / LOCALIDAD PREVIA A LA QUE ASISTIÓ

¿EL ESTUDIANTE HA ASISTIDO ALGUNA VEZ UNA DE LAS ESCUELAS DEL DISTRITO ESCOLAR DE

SEDRO-WOOLLEY? Si No SI Sí, ¿CUAL ESCUELA?

FECHA EN QUE ASISTIÓ (Mes /Año)

¿HA SIDO SUSPENDIDO ALGUNA VEZ EL ESTUDIANTE POR VIOLACIÓN DE ARMAS? Si No Fecha: _________________

¿HAY ALGUNA ORDEN DE RESTRICCIÓN EN EFECTO? Sí No (Si sí, los papeles legales tiene que estar archivados en la escuela para

lograr cumplir las medidas en ellas.) Orden de Restricción en contra de: Madre Padre Otro

¿SU HIJO HA CALIFICADO OR MATRICULADO EN EL PROGRAMA DE EDUCACIÓN ESPECIAL? Si No

¿ALGUNA VEZ SU HIJO HA CALIFICADO PARA O HA TENIDO EL PLAN 504? Si No

¿ALGUNA VEZ SU HIJO HA PARTICIPADO EN?: Título LAP Talento ELL Otro _________

¿HA REPROBADO EL

ESTUDIANTE ALGÚN GRADO?

Si No Si sí, ¿qué

grado(s)?____________________

¿El ESTUDIANTE ASISTE A LA GUARDERÍA?

Antes Después Antes y Después de la escuela

PROVEEDOR DE GUARDERÍA Nombre Dirección Teléfono

ARREGLOS ADICIONALES DE LA GUARDERÍA (Por favor provea la información por escrito a la escuela)

ENLISTE LOS OTROS HERMANOS y HERMANAS QUE ASISTEN A LAS ESCUELAS DEL DISTRITO ESCOLAR DE SEDRO-WOOLLEY

Apellido Primer Nombre Escuela Grado

Durante una herida, enfermedad u otras situaciones no-urgentes que ocurran e involucren a su hijo, queremos poder localizar rápidamente a

la familia o a otros adultos responsables. En caso de que no podamos localizar al padre /guardián, por favor anote los nombres de personas

de su confianza que puedan proveer cuidado para su hijo durante el día.

Primer Contacto (otro que no sea el padre/ guardián)

Apellido Nombre

RELACIÓN CON EL NIÑO Teléfono De Casa

( )

Teléfono Del

Trabajo

( )

Teléfono

Celular

( )

Dirección del Primer Contacto Calle Ciudad Estado Código Postal

Segundo Contacto (otro que no sea el padre /guardián)

Apellido Nombre

RELACIÓN CON EL NIÑO Teléfono De Casa

( )

Teléfono Del

Trabajo

( )

Teléfono

Celular

( )

Dirección del Segundo Contacto Calle Ciudad Estado Código Postal

Tercer Contacto (otro que no sea el padre /guardián)

Apellido Nombre

RELACIÓN CON EL NIÑO Teléfono De Casa

( )

Teléfono Del

Trabajo

( )

Teléfono

Celular

( )

Dirección del Tercer Contacto Calle Ciudad Estado Código Postal

AUTORIZACIÓN DE ENTREGO DEL ESTUDIANTE En caso en que la escuela no pueda ponerse en contacto con el padre/ guardián,

yo autorizo que mi hijo sea entregado a una de las personas anotadas arriba.

Firma del Padre Legal _________________________________________________ Fecha _____________________

INFORMACIÓN DEL DIRECTORIO: Cierta información conocida como “Información de Directorio”, que es definida por El Acta

Privada y los Derechos Familiares Federales puede ser publicada, a menos que Usted haga petición por escrito que tal información no sea

publicada. Nosotros no publicamos ninguna “Información del Directorio” para propósitos comerciales ni por otras razones que no están

relacionadas a la conducta de asuntos escolares.

Si Usted desea que la Información del Directorio no sea publicada, por favor firme aquí:

Firma del Padre Lega l _______ ___________________________________________ Fecha____________________

Ocasionalmente se toman fotografías de los estudiantes para los medios de prensa o publicaciones del distrito.

Si Usted desea que su hijo no aparezca en fotografías, grabación, película o en diapositiva, por favor firme aquí:

Firma del Padre Legal _________________________________________________ Fecha____________________

VERIFICACIÓN: La información proveída en esta forma es verdadera, precisa y actual en esta fecha. Entiendo que la falsificación del

domicilio o el uso de cualquier medio fraudulento para lograr la matriculación asignada, causará la revocación de la matriculación del

estudiante y será asignado para asistir a la escuela de su área. Es la responsabilidad del padre en notificar a la escuela cualquier cambio de

domicilio y / o número de teléfono.

Yo, con mi firma, aquí autorizo a los oficiales del Distrito Escolar de Sedro-Woolley para que se pongan en contacto directamente con las

personas nombradas en esta forma de registro, y autorizo al doctor asignado para que de servicio y el tratamiento de emergencia necesario

para la salud de mi hijo. En tal evento que los doctores u otras personas nombradas en este documento, y los padres no se puedan encontrar,

los oficiales de la escuela están autorizadas tomar cualquier acción que ellos juzguen necesaria, por la salud de mi hijo. No lo considerare

económicamente responsable al Distrito Escolar por el cuidado de emergencia y/ o la transportación de mi hijo.

Firma del Padre Legal _________________________________________________ Fecha ______________________ RRV-Revised 5/16/08

INSTRUCCIONES ESPECIALES TOCANTE A LAS CREENCIAS RELIGIOSAS (Por favor provea la información por escrito a la escuela)

SEDRO-WOOLLEY SCHOOL DISTRICT

HEALTH INFORMATION

NAME Male Female Grade

Last First Middle

CHECK HERE IF THERE ARE NO KNOWN HEALTH PROBLEMS

Conditions which your child has:

ADD/ADHD Fainting Spells Mental/Emotional Problems

Asthma Frequent Headaches/Migraines Orthopedic/Bone Problems

Cancer Hearing Problems Seizures/Convulsions

Counseling Heart Condition Vision Problems

Diabetes Kidney/Bladder Disease Other

If yes please explain:

Allergy to: Medications Bee Stings Foods Other

If yes please explain:

Are any of the above conditions life-Threatening? Yes No

Has a doctor diagnosed any of the above conditions? Yes No

Doctors Name: Phone number

What does your child do to manage their own condition?

Does your child have a physical condition, which limits participation in classroom activities or physical education?

Yes No If yes explain:

Does your child take any medication on a daily basis? Yes N

Medication Dosage For (Diagnosis) Taken at home/school/both

IF YOUR CHILD MUST RECEIVE MEDICATION WHILE AT SCHOOL, AN "AUTHORIZATION FOR

MEDICATION" FORM MUST BE COMPLETED AND SIGNED BY THE ATTENDING PHYSICIAN

AND PARENT(S) OR LEGAL GUARDIAN(S) OF THE CHILD (RCW 28A.210.260). YOU CAN OBTAIN

THE FORM FROM THE SCHOOL OR DOCTOR’S OFFICE. ALL MEDICATIONS NEED TO BE

BROUGHT TO SCHOOL BY AN ADULT. YOUR CHILD CANNOT BRING IN ANY MEDICATION OF

ANY KIND, PRESCRIPTION OR OVER THE COUNTER

This information is considered confidential and is for use of the nurse, teachers, principal or other staff who will be

in contact with responsible for your child during the school day.

Parent/Legal Guardian’s signature Date

Washington State- Ethnicity and Race Data Collection Form (Evergreen Elementary)

New federal requiren1ents state that ''Unknown" "Multiracia” and "not provided" are no longer valid responses to

ethnicity or race identification questions. If parents, guardians, or students do not provide ethnicity and race

information, districts are responsible for assigning categories based on observation or prior ethnicity and race data.

Please identify the ethnicity and race of the student by answering BOTH quest ions .

Student Legal Last Name Legal First Name

(please print)

(please print)

Question 1. Is your child of Hispanic or Latino origin?

No, check all that apply for Question 2

Yes, check all that apply for Question 1 and Question 2

0 Cuban 0 Central American

0 Dominican 0 South American

0 Spaniard 0 Latin American

0 Puerto Rican 0 Other Hispanic/Latino

0 Mexican/MexicanAmerican/Chicano

Question 2 What race(s) do you consider your child? (check all that apply)

0 African I African American

/ Haitian I Black

0 Caucasian/ European/Russian/Middle Eastern/ North African/White

Asian

0AsianInd1an

0Cambodian

0Chinese

0Filipino

0Hmong

0Japanese

0Korean

0Laotian

0Malaysian

0Pakistani

0Singaporean

0Taiwanese

0Thai

0Vietnamese

0Other Asian

Native Hawaiian or other Pacific Islander

0Native Hawaiian

0 Fijian

0Guamanian or Chamorro

0 Mariana Islanders

0 Melanesian

0Micronesian

0Samoan

0Tongan

0Other Pacit1c Islander

American Indian or Alaskan Native

0Alaska Native

0 Chehalis

0 Colville

0Cowlitz

0 Hoh

0Jamestown

0Kalispel

0Lmver Elwha

0Lummi

0Makah

0Muckleshoot

0Nisqually

0Nooksack

0Port Gamble Klallam

0Puyallup

0Quileute

0Quinault

0Samish

0Sauk-Suiatlle

0Shoalwater

0Skokomish

0Snoqualmie

0Spokane

0Squaxin Island

0 Stillaguamish

0Suquamish

0Swinomish

0Tulalip

0Upper Skagit

0Yakama

0Other Washington Indian

0Other North, Central or South

American Indian

Parent/Guardian Signature Date

Parent/Guardian Name (please print clearly)

Sedro-Woo!ley School District, No. 101 Home Language Survey Washington State Transitional Bilingual Instructional Program

Student's Name Date School Grade SSID--:- . - Date of Birth Gender 1. Is a language other than English spoken in the home"' __ Yes --No

If yes, list language(s) Language(s) most often used by: Father Mother Guardian

12 Is yocr child's FIRST 'anguage a language OTHER than Eng'ish' Yes No

lf ye:s, list language(s)

Student's Country of Origin

Parert or Gu3rdtan's Nar'e

I AddreSS

Parent or Guardian's Si nature Reference to WAC392-160·DOS.

r­Lil\

Phone 1\urnber

__ _j __ J . --·--·~

Date

l

"Primary language" means the language mo::l often usee! by a stud9nt (not necessan.:/ by parents. guardliYS, or others) for communication m the student'.! olace of residence:. "Eligible studenr means any student who m&els fhf: following two conditions·

(a) The primary language of the ~tudenl must be clher than E:·gfJsh; and (b) The sludenf's English skJJ/s must be sufficienlly deficJenl or absent/a irnpair learr;11g

Please Complete the Following if you answered YES on question #2:

A, __ For how many YEARS has the student attended school in the United States (grades K- 12) before enrolling in this district? Last school attended _____ _

B. For how many YEARS has the student received formal education outside the United States in his/her native language (equivalent to grades K- 12) before enrolling in this district?

Guidance: One (1) school year = ten ( 10) months. "Formal education" does not include refugee camp schools or other unaccredited programs for ch!ldr€:n "Native Language" refers to the fam:ly's dom·lant language.

·e-~rr:~_ ~~~a~~: .. ~:~ If THE A.NSWER TO QUESTJON NCYIBER TWO ABOVE WAS "YES": REFER THE STlJDENT FOR TESTING ON THE WASHJNGTON LANGUAGE PROFICIENCY PLACEMENT TEST_

Bilingual Eligible (circle one) YES NO : ELL Staff Name ___________ _

Qualified per (circle one) WLPT II Placement

\\'tihington State Transilional Bilmgual lnstructtonal Program Rei'ISui August 2006

OSPI Data Other ____ _

Eng.:.~h Ht.S SWSD ReviSion l/2008

Revised 8/25/09

EVERGREEN ELEMENTARY

1007 MCGARIGLE ROAD

SEDRO-WOOLLEY WA 98284

PHONE # 1-360-855-3545 FAX # 1-360-855-3546

scann@swsd.k12.wa.us

REQUEST FOR TRANSFER OF EDUCATIONAL RECORDS BETWEEN SCHOOLS

The following student is enrolling at Evergreen Elementary School:

Name Birth Date Grade

Name Birth Date Grade

Name Birth Date Grade

SCHOOL TRANSFERRING FROM:

School Name

Street City State Zip

Phone Fax

School District County

URGENT:

The above named student is enrolling at Evergreen Elementary School. Please indicate if the student has an IEP or if the

student has been expelled for a weapons violation in the last year.

Please send by mail:

____Report card showing student’s academic progress.

____Copies of test scores and MSP scores (if applicable)

____Health record and dates of immunization (please fax shot records ASAP)

____Student’s cumulative file

____Copy of attendance and disciplinary records

____Copy of student’s Section 504 Accommodation Plan

School Official Date

Stephanie Cann/Terril Moore

Release of Attendance

____________________, has been attending __________________________________, per a signed non- (Student) (School)

resident application. It has come to our attention that he/she wishes to attend school in the

________________________________________ School District. Per Washington State Requirements, it is necessary for

_________________________________________, to release the student back to the Sedro-Woolley School District. (School)

Effective date of release back to the Sedro-Woolley School District is:________________________________. (Effective Date)

_____________________________________________ ___________________

Releasing School District Authorized Signature Date

_____________________________________________

Title

Revised 8/25/09

RCW: 28A.225.330

1. When enrolling a student who has attended school in another district, the school enrolling the student may request the parent and the student to briefly indicate in

writing whether or not the student has:

a. Any history of placement in special education programs;

b. Any past, current or pending disciplinary action;

c. Any history of violent behavior, or behavior listed in RCW 13.04.155;

d. Any unpaid fines or fees imposed by other schools; and

e. Any health conditions affecting the student’s educational needs.

2. The school enrolling the student shall request the school the student previously attended to send the student’s permanent record including records of disciplinary

action, history of violent behavior listed in RCW 13.04.155, attendance, immunization records, and academic performance. If the student has not paid a fine or

fee under RCW 28A.635.060 or tuition, fees, or fines at approved private schools the school may withhold the student’s official transcript, but shall transmit

information about the student’s academic performance, special placement, immunization records, records of disciplinary action, and history of violent behavior or

behavior listed in RCW 13.04.155. If the official transcript is not sent due to the unpaid tuition, fees, or fines, the enrolling school shall notify both the student

and parent or guardian that the official transcript will not be sent until the obligation is met, and failure to have an official transcript may result in exclusion from

extracurricular activities or failure to graduate.

3. If information is requested under subsection 2 of this section, the information shall be transmitted within two school days of receiving the request and the records

shall be sent as soon as possible. Any school district or district employee who releases the information in compliance with this section is immune from civil

liability for damages unless it is shown that the school district employee acted with gross negligence or in bad faith. The professional educator standards board

shall provide by rule for the discipline under chapter 28A.410 RCW of a school principal or other chief administrator of a public school building who fails to

make a good faith effort to assure compliance with this subsection.

4. Any school district or district employee who releases the information in compliance with federal and state law is immune from civil liability for damages unless it

is shown that the school district or district employee acted with gross negligence or in bad faith.

5. When a school receives information under this section or RCW 13.40.215 that a student has a history of disciplinary actions, criminal or violent behavior, or

other behavior that indicates the student could be a threat to the safety of educational staff or other students, the school shall provide this information to the

student's teachers and security personnel.

Note: If you are withholding information due to fines/fees owed by this student, please see the above RCW.

Family Involvement Policy

Family Involvement is the key to student success. This Policy outlines your rights to be involved

Schoolwide Title 1

Information about our Schoolwide Title 1 Program, your right to be involved, description and explanation of curriculum, student assessment methods, and ex­pected proficiency levels will be shared with all fami­lies at our annual Title 1 Parent Orientation meeting, our open house in September, and at parent confer­ences in October. Information is also shared in our

Helping all students succeed newsletter, website, and Evergreen Booster Group

Meetings. Our hope is that through one of these op­portunities you will be informed and have any ques­

tions or concerns addressed. Our principal, Mr. Isakson, or Title teachers, Mrs. Studebaker and Mrs. Garrett, are available at anytime through a visit, phone call, or email to answer your questions.

We annually conduct Parent/Teacher/Student conferences in October. Individual student progress during the first trimester will be discussed with parents during that time. Also, March conferences provide additional time for classroom teachers, the counselor, and Title staff to further apprise parents of their student's pro­gress. In addition to conferences classroom teachers, instructional support specialists, ELL staff and special education staff will provide feedback for parents relative to the progress of their student throughout the year in a variety of ways, including phone calls, news­letters, progress reports, and report cards

Evergreen Elementary 360-855-3545

Evergreen Elementary Schoolwide Title 1 Student/Parent/Educator Compact

Partners in Learning Student's name ____________ _ Date, ________________ _

AS A PARENT/GUARDIAN, I WILL ENCOURAGE MY STUDENT'S LEARNING BY:

• Recognizing/emphasizing the importance of education

• Showing interest in my student's education by monitoring homework/assignments

• Communicating with teachers through notes, phone calls, e-mail, and conferences

• Modeling respect for school employees and other students

• Reading with/to my child on a regular basis

Parent Signature ___________________ _

AS A STUDENT, I WILL BE AN ACTIVE PARTNER IN MY OWN LEARNING BY:

• Attending school regularly and promptly

• Being an attentive learner/listener in class

• Respecting my teachers/school employees/other students

• Completing my assignments/homework on time

• Following school and classroom rules

Student signature ______________________ _

AS AN EDUCATOR (PRINCIPAL/TEACHER/SUPPORT STAFF), I WILL ENCOURAGE AND SUPPORT STUDENTS' LEARNING BY:

• Demonstrating care and concern for each student

• Recognizing students' individual learning styles and needs

• Providing a variety of supplemental academic programs

• Maximizing students' academic time on task

• Promoting positive self esteem and self-confidence in all students,

Principal Signature ____________________ _ Teacher Signature _____________________ _

Family Involvement Policy

Parents will receive a copy of the Evergreen Elementary Schoolwide Title 1 Compact, which is an agreement between home and school, outlining each person's individual responsibility for supporting student learning. This docu­ment needs signatures from the student, parent/guardian, teacher and princi­pal. We all share in the responsibility of educating our children.

Schoolwide Title 1 ... helping ALL students succeed!

This Family Involvement Policy and our Schoolwide Title 1 Plan were developed jointly with and agreed upon by Parents/Guardians, Teachers and Administrators to best meet the needs of our students and families. Our Family Involvement Policy is annually distributed to all families in the fall of the school year. Our Schoolwide Title 1 Plan is available in our office for review upon request. The implementation of our School­wide Title 1 Plan is monitored throughout the school year. Any needed improvements or adjustments to the Schoolwide Title 1 Plan or Family Involvement Policy are made in the spring for the following school year. You can be involved in this process by filling out our Parent Survey conducted in March, by attending our Evergreen Booster Group meetings, or by sharing your feedback at anytime during the year with building staff. We need your comments to increase the effectiveness of our Family Involvement Policy and Schoolwide Title 1 Plan prior to submitting them to the District office at the end of the school year.

Evergreen Title 1 /LAP Staff: Brian Isakson, Principal bisakson@swsd.kl 2.wa.us Becky Studebaker, Teacher bstudebaker@swsd.k12.wa.us Belinda Garrett, Teacher bgarrett@swsd.k12.wa.us