Salinas High School EnrollmentWelcome to Salinas High School!

The Enrollment Process:1. Complete this packet and attach all required documents. It can be emailed anytime or

dropped off in person at the office, Monday-Friday 1:30pm to 3:00pm2. Student will be enrolled into the SHS student system3. Counselor will be assigned and will schedule the student4. Registrar’s Office will contact you via email or phone for schedule/Chromebook pickup

(Monday-Friday 1:30pm to 3:00pm)5. Parent/Guardian will be issued a ParentVUE Activation Key. Parent must activate their

account and complete the Online Registration. This can ONLY be issued to the parent.

In order to better serve your student and provide proper placement, the following is a list ofdocuments necessary for enrollment:

Immunization Records

_____ Copy of Birth Certificate

_____ 3 Proofs of Address — Must be CURRENT. Families enrolling must live in ourattendance area.

Transcript and Withdrawal/Drop Sheet from former school/program

If Applicable:_____ Special Education — Copy of latest IEP_____ Caregiver Affidavit w/ID and Proof of Address

Along with the documents listed above, please complete the forms included in this packet:• Student Data Transmittal• Prior School Enrollment• Student Residency Questionnaire• Student/Parent Signature Form• Health History

If you have any question or concerns, please call or email the Registrar/Registrar’s ClerkEmail: marilyn.espinoza2@salinasuhsd.org and naomi.macias@salinasuhsd.org

Phone: 831-796-7400 ext. 2919 and 2918

~~SUHSDp— .

ENROLLMENT AND ADDRESS VERIFICATiON REQUIREMENTS AND

GUIDELINES

Parents/Guardians and Students:

Pursuant to Government Code, Education Code, District Board Policy and Administrative Regulation, thefollowing is required in order to enroll a student in any school within the Salinas Union high School District.

~ Verification or Proof of residency within the school attendance area and within the school District.3- Approved transfer from another school or district (School Choice, Intradistrict Transfer Application,

interdistrict Attendance Transfer3- Immunization records.3- Birth Certificate

Note that there can only be one residence. (Government Code 244). To establish residency, a minimum of threeoriginal documents must be presented to the school registrar. The school registrar may request additionaldocumentation if the documents provided are not sufficient to verify residency within the school attendancearea or District. Additional verification of residency may be determined through home visits and other means

El’ there is evidence that false or incorrect residency Information has been submitted to the school registrar, thefamily will be referred to the office of Pupil Personnel Services, 20 Sherwood Place, Salinas, California and bedirected to enroll in the school or District of actual residency. If a student is enrolled and it is determined laterthat false or incorrect information was provided to enroll a student, the student will be dropped to the schoolor district of residency. No transfer applications will be approved due to false or incorrect residencyinformation.

Documents may Include any of the following:

• Property tax payment receipts (SUHSD Administrative RegulatIon #5111.1).Vehicle Registration (SUHSD AdmInistrative Regulation #5111.1 and #5114.14).Voter Registration (511USD Administrative Regulation #S111.1).

• Driver’s License (SUHSD Administrative Regulation #511 1.1).• Income Tax Returns (SUHSD Administrative Regulation #5114.14).• Any documents from local, state, or federal government (SUHSD Administrative Regulation

#5114.14). Examples: Social Service forms, tax records, utility bills.• Water, garbage, sewer bills wIth address of where service (a provided.• Television, cable, satellite, Internet service bills showing where service is provided,• Land fine phone bills.• Propertylhome insurance policies and bills showing the physical address.• Rental and Lease documents, not a simple receipt or a letter from another person and a print-out of a

ledger showing rent payment history.• Check stubs with physical address.

State Student ID:SALINAS UNION HIGH SCHOOL DISTRICT

District Student ID: STUDENT DATA TRANSMITTAL FORM

Legal Name (if different from above) Grade Level

Student’s Birthdate (Mo/Day/Yr): Birthplace: (City, State and Country) Home PhoneI I

Home Address: City Zip 10. Mailing Address (if different): City Zip

Student lives with: [ ]Parent(s) [ ]Father [ ]Mother [ ]Foster Parent [ JStep Parent[ ]Relative [ ]Court Appointed Guardian [ ]Other

Primary Guardian’s Last Name First MiddleRelation to Child:

Guardian’s Employer Work Phone:____________ Cell:

Secondary Guardian’s Last Name First MiddleRelation to Child:

Guardian’s Employer Work Phone:___________ Cell:

Describe the education level of the most educated parent: [ I Not a high school graduate [ I High school graduate [ J Some college(including AA) [ ] College graduate [ I Graduate School/Post Graduate training

[What is your child’s ethnicity? [ ] Hispanic or Latino [ ] Not Hispanic or LatinoWhat is your child’s race? The above part of the question is about ethnicity, not race. No matter what you selected above, pleasecontinue to answer the following by marking one or more boxes to indicate what you consider your race to be:

American Indian or Alaska Native [1 Asian Indian [ ]Black or African American [I Cambodian [ ]Chinese [I FilipinoGuamanian []Hawaiian [I Hmong []Japanese [1 Korean [ ] Laotian [ ] Vietnamese [I Other Asian [ JOther Pacific Islander

I Tahitian [1 White [ ] Pacific Islander [I Samoan

HOME LANGUAGE SURVEY:Language student first spoke: ________________ Language student speaks most often: ________________

Language I speak most with student is: ________________ Language adults speak in the home is: ________________

Information from school should be in: ________________

Indicate first year attended United States School: ______________________________Has student ever received any Special Education services? [ ] Yes [ ] NoDoes student have health problems that should be known by the District? [ ] Yes ~ I NoHas student ever been enrolled in Alternative Education (not Special Education)? [ ) Yes [ ] NoDoes student have a Section 504 plan? [ I Yes [ I NoHas this student ever been expelled from school? [ I Yes [ ] NoStudent had to move because of parent/guardian’s work in Agriculture or Fresh Food Processing, or Forestry, or Commercial Fishing

within the last three years: [ ] Yes [ I NoEmergency Contact Information: In case child listed above becomes ill or is injured at school and I cannot becontacted, the school authorities have my permission to contact and release my child to the custody Can pick up in a non-Of one of the following: emergency:Name: _________________________________ Relationship: ___________ Phone: _____________________ Yes[ ] No []Name: ___________________________________ Relationship: ____________ Phone: ______________________ Yes[ ] NoPhysician: ________________________________ Phone: ______________________

The hospital I prefer is: [I SVMH [ ] Natividad [I CHOMP [ ] Other _____________________________________

In an emergency due to illness or accident, when we cannot be contacted, the school authorities have our permission to use their bestjudgment in the interest of our student’s health. We understand the school assumes no financial responsibility for medical care orambulance transportation in case of an emergency.

I certify by my signature that all the information given above is accurate to the best of my knowledge.Signed by: [ ]Parent [ ]Guardian [ ]Other - Special relationship ___________________________

Signature:______________________________________________________ Date:__________________________________Parent’s/Guardian’s EMAIL Address: _______________________________________________________________________

Student’s EMAIL Address:

HSD 18 (REV:12114) White - Registrar/Gum Yellow - Health Aide Pink - Migrant Office

Was student previously enrolled in this district? [ ]Yes Grade(s) School(s) [ ]No

Student’s Last Name First Middle [ ) Male4 ]Female

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Student’s Legal NameLast, First, Middle

Has the student ever gone by a different name YES NO (circle one)

If yes, please give full name usedLast, First, Middle

Date of Birth Date of Enrollment_______________

Place of BirthCity State Country

Students Prior School EnrollmentUnder Federal legislation, the No Child Left Behind Act of 2001 (NCLB), all California public schoolsare required to implement a statewide accountability program that measures the progress of itsstudent’s and schools. The California School Information Services (CSIS) Identifier is a ten digit,random numeric value that is stored at the student’s district so that it may be associated with thatstudent. In order to properly assign this number we need the student’s entire enrollment history.

School Ci , StateKindergarten1St Grade

2~ Grade3r Grade

4t Grade

5~ Grade

6t Grade

7t Grade

8t Grade

9t Grade

1 Ot Grade

lit Grade

12t Grade

Registrar — Please forward all parent completed affidavits to Community Liaison for verification.

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Filling out this form helps determine the services this student may be eligible to receive under the McKinneyVento Act42 U.S.C. 11435. This document is required by the California Department of Education for every student on a yearlybasis.

1. STUDENT INFORMATION

School: ______________

Student (legal name). _____________

Birthdate (month/day/year,):_______

Address:2. PLEASE CHECK THE BOX BELOW WHICH BESTDESCRIBES YOUR CURRENT LIVINGARRANGEMENT

Li Rent or own a home, mobile home, apartment, or condominium (Ifyou checked this box, please proceed to #4)

Li Living in a house or apartment with another family (120)

Li I have lived here for less than 1 year

Li I have lived here more than 1 year

Li A shelter — family, domestic violence or transitional living program (100)

Li Car, park, garage, campsite, any building without water or electricity (Unsheltered) (130)

Li Motel/hotel. Motel/hotel name: _____________________________________________________ (1 10)

~ 3. DOES YOUR LIVINGARRANGEMENTRESULTFROMANYOF THE FOLLO WING?Financial difficulties El Yes El No

I declare under penalty of perjury under the laws of California that the information provided here is true andcorrect and that, if called upon to testify, I would be competent to testify.

Signature of parent/guardian/caregiver/adult: _____________________________________ Date: _________________

Print your first and last name: _________________________________________________________________________

For School Site OnlySchool Community Liaison School Registrar

Meets Criteria: Residency Code: Li Student has been marked as Youth in Transition in SynergyLi YES (will remain with this status for the remainder qf the school

Li NO year,).Transportation Needed: Community Resources: Li Original form to be filed in the student’s cum.

Li YES

U NOSupplies: Migrant Student:

Li YES ~ YES Registrar Initials: Date:Li NO Li NO

Community Liaison Initials: Date:

Community Liaison: Please return verified form to registrar for Synergy/cum documentation. R~’~’~’~/.• 4 ~ Y)IYAPG- MV_UT

SALINAS UNION HIGH SCHOOL DISTRICTStudent Residency Questionnaire

Grade (7-12): ID#: _____________

~ Male ~ Female

Parent/Guardian Phone #:

Loss of previous living situation U Yes

4. DOCUMENTATION

ElNo

STUDENT/PARENT SIGNATURE FORMFormulario de Firmas de los Padres/Estudiante

Student’s Last Name/Apellido delEsludiante First NamelNombre Grade Level/Grado

School/Escuela BirthdatelFecha de Nacimiento Student TD/Nthnero-Identidad de Estudiante

We have received the “Notification of Parents’ Rights and Responsibilities” and have read and discussed thecontents of it including the Attendance Policy and the Student Behavior Manual (noticed per E.C. 35291).We understand that no student may enroil until this form is signed and returned to the school (Nosotros hemosrecibido la “Notiflcación de lot Derechos y las Responsabilidades de los Padres” y hemos leI4o y hablado del contenido de asiainformación induyendo las Reglas de Asi.vtencia y el Manual de Conducta de lot Estudiantes (notzficado segün C.E. 35291).Nosotros entendemos que ningán estudiantepuede inscribirse en la escuela hasta qua este documento sea firmado y regresado ala escuela.)

We have also received and have read and discussed the Internet Acceptable Use Policy. We understand andagree to the parameters for student participation In the use of the internet va the Salinas Union High SchoolDistrict’s computers and network. (Nosotros tambi~n heinos recibido las Reglas de Usos Aceptados del Internety hemosleldo y hablado de estas reglas. Nosofros entendemos y aceptamos las guias y reglas para que el esludiante use el Internet enlas computadoras y las redes del Salinas Union High School District.)

Date/Fecha

Student Signature:Firma del Estudiante

Mother/Guardian Signature:Firma de la Madre/tutora

Father/Guardian Signature:Firma del Padre/tutor

Telephone Number: Home:Ngmero telefónico Hogar

Work (Mother):Trabajo (Madre)

Work (Father):Trabajo (Padre)

Email Address (Dirección de Cosreo Electrónico):

Emergency Name (Nombre de emergencia):

Telephone (Tel~fono): Relationship (Parentesco):

NOTE: The above signatures may be used to verify the validity of notes submitted to the schooL(NOTA: La escuela usard lasfirmas de arriba como comprobantespara verzficar las notas entregadas a la escuela.)

No student may enroll until this page has been signed and returned to the school.(Ningi~n astudiantepuede matricularse hasta que sefirmey se regrese este documento a Ia escuela.

Salinas Union High School DistrictHealth History

Name of Child School ________________________

Date of Birth _____________________ID#___________________________________

Health Issues:(Check if your student currently has one of the below listed health problems.)D Diabetes C ADHD C Anaphylaxis (Severe Allergy)C Asthma C Drug/Alcohol Abuse Allergy to: _______________________C Seizure Disorder C Other:

If they are on medication(s) for any or all of the boxes checked please provide the school with acompleted Orderfor Administration ofMedication at Schoolform.

List Current Medication Taken:

L Name of Medication Dose Time(s) Taken HCheck this box if Orderfor Administration ofMedication at School has been completed with thispacket. CA new Administration ofMedication form must be completed each new school year, for allmedications, including prescription medication(s).

Is your child allergic to any medication? If yes, please list:______________________________

Is your child physically able to fully participate in school actives? Ifthe answer is no, we musthave a doctor’s note excusing your child with an explanation of what activities to avoid andsuggestions for activities approved with a start date and an end date.

Does your child have hearing issues? (Circle) If yes do they have hearing aids Yes or No.If yes are they under a doctor’s care? (Circle) Yes or No.

Does your child have eye trouble or difficulty seeing? (Circle) If yes, are they under a doctor’scare? Yes or No. If they have been prescribed glasses please have your child come to school withthem. Does your child wear glasses? (Circle) Yes or No.

Over the course of the school year, the SIJHSD will be performing a State Mandated HealthScreening for vision and hearing. If you do not wish for your child to be screened please checkthe box.Q

Parent Name Parent Signature Date________

Emergency Contact Name -- Phone Number ________________

431 West Alisal Street, Salinas, CA 93901 . Phone: (831) 796-7000 Fax: (831) 796-6977 . www.salinasuhsd.org

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Grade______

Rev. 4/2018, CW, DA