Embed Size (px)
Citation preview
Jenison International Academy
Enrollment Checklist
The Jenison International Academy will allow learners in grades 7-12 to learn in an online community that fosters independence, critical
thinking, creativity and problem solving skills. Our alternative learning environment will provide high quality standards-driven curriculum
that will allow the students to learn anytime and anywhere.
Student Name ___________________________________________________________
REQUIRED DOCUMENTATION:
____ LEARNER INFORMATION (completed)
____ STUDENT RECOMMENDATION FORM (completed)
____ CONTRACT FOR ONLINE LEARNERS (signed and dated)
____ TECHNOLOGY REQUIREMENTS/WAIVER
____ ACADEMIC BENCHMARKS (signed and dated)
____ ENROLLMENT FORM (completed)
____ STUDENT PERMISSIONS FORM (completed)
____ STUDENT RESIDENCY QUESTIONNAIRE (completed)
____ PROOF OF RESIDENCY AND/OR SCHOOLS OF CHOICE APPROVAL
School personnel must have a copy of an assessment/property tax statement, rental/lease agreement (must include landlord’s
telephone number), or current utility bill. (Not a driver’s license or voter’s registration card.) School of Choice form is required if
residency is outside the JPS boundaries and is attached to this packet.
____ BIRTH CERTIFICATE An original certified/state issued birth certificate that can be viewed and copied by JPS.
____ IMMUNIZATION RECORD State law requires that your child’s immunization must be up-to-date or your child cannot enter school. Make sure the exact month,
day and year of the immunizations are listed.
____ COURT DOCUMENTATION IN THE EVENT OF CUSTODY ISSUES (if applicable)
____ COPY OF MOST RECENT SPECIAL EDUCATION IEP (if applicable)
____ REQUEST FOR SCHOOL RECORDS FORM (if applicable)
____ TRANSCRIPT FROM PREVIOUS SCHOOL (if applicable)
CONTACT INFORMATION:
Rebekah Redmer, Director
2140 Bauer Rd., Jenison, MI 49428
Phone: 616-457-3400, x-3365
Fax: 616-457-4070
Jenison International Academy
Jenison Public Schools
Application
The Jenison Public School District is participating in a state approved seat time waiver program in accordance with the pupil accounting rules
and Section 5-O-B of the Michigan Department of Education Pupil Accounting Manual.
Learner Information
Currently Enrolled In School District: __________________________________________ Grade: _________
Home School Grade Level: ________________
Reason for Application Home Schooled Accelerated Learning High interest course
Schedule Conflict Other: ___________________________________
Learner Name
Birthdate
Learner Email Address
Parent/ Guardian Name
Parent/ Guardian Email
Home Address
Phone Numbers Parent: Learner:
Academic Performance
Current No. of Credits __________________ (H.S. attach transcript)
GPA: _________________ Expected Year of Graduation: _______________
No high school credits earned to date.
Technology
Computer at home? Yes No
Internet Access: Dial-Up High Speed Cable or DSL None
Skill using email? Excellent Somewhat Good Poor
Skill using word processing? Excellent Somewhat Good Poor
Skill using web browsers? Excellent Somewhat Good Poor
Experience with Online Classes? No Yes
If Yes, describe:
Jenison International Academy
Student Recommendation Form
Each student being considered for a seat time waiver must submit at least one recommendation from a non-family member that is
knowledgeable of the student. The recommendation can be from a previous teacher, elective teacher, coach, social worker or community
member.
Student Name: _______________________________________________________ Grade: __________
Name of Person Completing the Recommendation: __________________________________________
Position/Affiliation with the Student: _____________________________________________________
Phone Number: ______________________________________________________________________
Email: ______________________________________________________________________________
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
This student is applying for a seat time waiver educational program. The student will primarily be taking online
courses to earn credit toward high school graduation. The student will communicate with a mentor teacher from
Jenison one time per week, in addition to their online teachers. It is important to determine the student’s likelihood for
success based on recommendations from faculty and/or other adults affiliated with the student. Please complete this
confidential form and return it as soon as possible to: Becky Redmer, JIA Director, Jenison High School, 8375 20
Ave. Jenison, MI 49428. Please rate the student in the following categories:
Unknown
Below
Average Average
Above
Average Outstanding
Overall Academic Effort
Overall Academic Ability
Attitude Toward Learning
Reading Skills
Computer Skills
Experience with the Internet
Problem Solving Skills
Communication Skills
Social Skills
Relationship Skills
Support from Home
Self Starter / Self Directed
Organizational Skills
Time Management Skills
Potential for Success in Seat Time Waiver Program
Other helpful information you would like to share. Please attach additional sheet if necessary.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Jenison International Academy
Jenison Public Schools
Contract for Online Learners
Introduction
Welcome to Online Learning with the Jenison International Academy at Jenison Public Schools. Participation has
similar requirements to other courses at Jenison Public Schools. Learners are bound by the standards set forth by the
Board of Education within the Jenison International Academy standards and student handbook. The big difference is
learners are expected to be more independent in terms of learning and meeting the requirements established by the
course instructors, mentors, and coordinator.
Attendance
The learner will adhere to the school’s timelines for completion of course requirements. The district’s policies will
take precedence in meeting program requirements as dictated by the Department of Education.
It is suggested that the learner spend at least one hour a day per online course and communicate with the online
teacher on a regular basis. It is expected that the learner will log in to course(s) on certain days as required.
Attendance for weekly mentor contacts is mandatory. If an absence is unavoidable and reasonable, the learner must
communicate with the mentor prior to the scheduled weekly contact and reschedule it at the mentor’s convenience.
More than two (2) missed weekly contacts per term is subject to removal from the program.
Learner Commitment
It is expected that the learner will:
Be committed to the course(s), adhere to the course schedules as prescribed, and understand that drops will be
allowed only as outlined by the online provider and the local district.
Work according to pacing guides in order to complete the requirements of the course.
Refrain from inappropriate use of information with any online course.
Follow all other rules as specified by the district, mentor and on-line teacher.
Parent/Guardian Commitment
It is expected that parents’/guardians’ participation in a child’s education will help determine his/her likelihood of
success. Therefore, parents/guardians are expected to monitor and support the child in his/her studies, agree to be
accessible to the mentor to discuss the child’s progress, and promote good attendance and time management of the
child’s participation.
Acceptable Use Policy
It is the responsibility of the learner to know the contents of any Acceptable Use Policies that apply in addition to the
Informational Technology Code of Ethics of Jenison Public Schools. Anything that learners do in the course(s) taken
can be retrieved and monitored by the mentor/coordinator/instructor at any time.
INFORMATIONAL TECHNOLOGY CODE OF ETHICS The use of information technology in the Jenison Public Schools is an opportunity extended to student and staff to enhance learning, productivity, and information processing. The computer hardware and software shall be used solely for educational purposes. The use of computer hardware and software for the purpose of sending or receiving inappropriate information is strictly prohibited. Students are responsible for:
Using hardware and software in a manner that enables its ongoing usage. Adhering to rules, including but not limited to, those posted in classrooms or computer labs or otherwise
specified by school employees for use of hardware, software, labs, and computer networks. Obtaining permission from a school official before bringing their own software and using it on school equipment.
Avoiding installing computer viruses or enabling the spread of such viruses on school equipment. Keeping hardware and software from being removed, relocated, or modified without permission from an
administrator. Maintaining the privacy of passwords. All material received from sources outside of the school, including the internee, and for accepting responsibility
for keeping all pornographic material, inappropriate text files, or files dangerous to the integrity of the school’s network and equipment from entering the school.
Adhering to the law and District policy pertaining to copyright and privacy rights in the use of equipment and in the transmission or copying of text or files.
Avoiding using the technology for personal or private business. Avoiding the malicious use of information technology to disrupt the use of technology by others, to harass or
discriminate against others, or to infiltrate unauthorized computer systems.
Students violating any of these responsibilities will face disciplinary action which may include:
Banning their use of school information technology. Making full restitution for expenses or damages caused. Attending training sessions. Facing additional disciplinary action deemed appropriate.
Tests/Exams
The online provider may require all or some of the tests/exams to be proctored by the mentor or other responsible
adult. Arrangements will be made with the mentor as needed. Learners enrolled in the district seat time waiver
program must take the grade appropriate state assessment exam. (See the Academic Benchmarks document.)
Technology
A computer will be offered to learners enrolled under an approved seat time waiver that includes internet capacity and
appropriate software configuration for use by the pupil in the home for the length of time that the pupil is enrolled in
the seat time waiver program. The broadband internet capacity shall be a minimum of 1 Mbsp up/3Mbsp down for
use in the home for the length of time that the pupil is enrolled in the seat time waiver program. Where broadband
access is severely limited, the Michigan Department of Education must give written approval of “offline” computer-
based delivery of instruction and an alternative means of providing teacher-pupil interaction shall be required and
shall be documented. Parents/Guardians can/should opt-out if access is adequate at home.
It is the responsibility of the learner to have access to the Internet when working on the courses outlined in the seat
time waiver program. If the learner loses internet connectivity, it must be communicated to Jenison Public Schools
within 24 hours to make alternative arrangements.
Course Costs
Jenison Public Schools will bear the cost of approved online courses taken during the 2011-12 school year if the
learner is registered in the district. Failure to meet the guidelines in this contract will result in reimbursement to
Jenison Public Schools of the costs incurred.
Jenison Public Schools Transcript
All final scores provided by the instructor will be converted to a letter grade as per the Jenison Public Schools
handbook and will be listed on the learner’s transcript and included in the cumulative Grade Point Average (GPA).
Cheating/Plagiarism
Cheating is considered a serious academic offense. Examples of cheating include, but are not limited to:
A. Unauthorized sharing of test answers.
B. Unauthorized sharing of class assignments or homework.
C. Plagiarism
For purposes of this offense, plagiarism is defined as: the unauthorized representation of another’s work
as one’s own. In addition, any unethical practice which compromises the integrity or teacher’s intent of
an assignment, test or quiz such as (but not limited to) the use of unauthorized resources (calculator,
teacher materials, textbooks, another learner’s work, etc.) shall be deemed to be cheating or plagiarism
and will result in the following disciplinary action:
1st Offense – Loss of grade for assignment, parent and administration informed.
2nd
Offense – Loss of grade for assignment, suspension from class until a conference is held with
parents and administration, and possible failure of course.
3rd
Offense – Automatic failure/loss of credit of course. Learner/Parents to cover cost of course.
The administration reserves the right to treat subsequent offenses in separate school years at the second and/or
third offense levels.
Contract Violation
Consequences for violation of provisions of this contract:
1st Offense – Verbal warning, parents and local school district administration notified.
2nd
Offense – Written warning, parents and local school district notified. Possible removal from program at
discretion of district administration.
Seat Time Waiver Signatures
___________________________________________________________ _______________
Designated School Office Signature / Title Date
Learner Acknowledgment and Understanding
As a student enrolled in a Seat Time Waiver program, I am aware that it is a privilege to participate in this program
and, therefore, I am expected to adhere to the highest codes of conduct and integrity as a representative of my school
district. I have read, understand, and acknowledge all the expectations and the policy as set forth in this document. I
agree to abide by the guidelines as stated.
___________________________________________________________ _______________ Learner Signature Date
Parent/Guardian Acknowledgment and Understanding
As my child’s Learner Coach, I have read and understand the policies and stated expectations for my child and agree
to support the seat time waiver program expectations. I understand that participation in my child’s education will
help determine his/her likelihood of success in the program. Therefore I will monitor and support my students in
his/her studies. I agree to be accessible and readily available to the mentor to discuss my child’s progress and
development. I understand time managements and attendance is vital to the student’s success. I understand
acceptance into this program is a privilege and my child must maintain the contracts and program policies in order to
remain enrolled. Failure to follow these policies may result in dismissal from the program.
___________________________________________________________ _______________ Parent/Guardian Signature Date
Jenison International Academy
Jenison Public Schools
Technology Requirements/Waiver
In accordance with the Michigan Department of Education Pupil Accounting Manual 5-O-B A.6.a. and A.6.b., a
computer will be offered to learners enrolled under an approved seat time waiver that includes internet capacity and
appropriate software configuration for use by the pupil in the home for the length of time that the pupil is enrolled in
the seat time waiver program. The broadband internet capacity shall be a minimum of 1 Mbsp up/3 Mbsp down for
use in the home for the length of time that the pupil is enrolled in the seat time waiver program. Where broadband
access is severely limited, the Michigan Department of Education must give written approval for “offline” computer-
based delivery of instruction and an alternative means of providing teacher-pupil interaction shall be required and
shall be documented.
Waiver of Technology Requirements
I have read and understand the technology requirements and choose to waive my rights to have Jenison Public
Schools provide a computer and internet access due to having adequate availability of a computer and internet access
already in the home.
Parent/Guardian: _____________________________________________ Date: _____________
Coordinator: ________________________________________________ Date: _____________
Jenison International Academy
Jenison Public Schools
Academic Benchmarks
The Jenison International Academy is committed to high academic standards and will require seat time waiver
learners to validate their learning by the following assessments as required in the Michigan Department of Education
Pupil Accounting Manual (5-O-B: Seat Time Waiver):
1. Grade Appropriate Assessment – Pupils enrolling in a Jenison International Academy seat time waiver
program must take the grade appropriate state assessment exam.
2. Michigan Merit Examination (MME/ACT) – Pupils enrolled in a Jenison International Academy seat time
waiver program and are at Junior status must take the MME/ACT as scheduled by the Department of
Education’s Office of Assessment and Accountability.
Jenison Public Schools will provide a learner with the testing materials at a location and time to be announced.
Jenison International Academy learners and parents/guardians will be notified of the dates and location of the
appropriate testing. Learners and parents/guardians will be responsible to be in attendance for the appropriate
exams.
State assessments are required for:
Grades 6 social studies
Grades 6-7-8 reading (2 days)
Grades 6-7-8 math
Grade 7 writing (2 days)
Grade 8 science
Grade 9 social studies
Grade 11 Michigan Merit Exam (3 days)/ACT
Learner & Parent/Guardian Acceptance
of Academic Benchmarks Requirements as stated above
Learner (print)
Learner (signature)
Date
Parent/Guardian (print)
Parent/Guardian (signature)
Date
Jenison International Academy
Student Graduation Plan Worksheet
Last Name: ________________________________ First Name: _____________________________ Year of Graduation: _________
English Year 1 CR Year 2 CR Year 3 CR Year 4 CR
Total English (4 Credits)
Social Studies Year 1 CR Year 2 CR Year 3 CR Year 4 CR
Total Social Studies (3 Credits)
Mathematics Year 1 CR Year 2 CR Year 3 CR Year 4 CR
Total Mathematics (4 Credits)
Science Year 1 CR Year 2 CR Year 3 CR Year 4 CR
Total Science (3 Credits)
Physical Education & Health Year 1 CR Year 2 CR Year 3 CR Year 4 CR
Total Physical Education & Health (1 Credits)
Visual, Performing or Applied Arts Year 1 CR Year 2 CR Year 3 CR Year 4 CR
Total Visual, Performing or Applied Arts (1 Credits)
Online Experience Year 1 CR Year 2 CR Year 3 CR Year 4 CR
Total Online Experience (1 Credits)
Foreign Language (beginning with class of 2016) Year 1 CR Year 2 CR Year 3 CR Year 4 CR
Total Foreign Language (2 Credits)
Electives Year 1 CR Year 2 CR Year 3 CR Year 4 CR
Total Electives (6 Credits)
Students must attempt a minimum of 24 credits and need 22 credits to graduate.
Students must enroll in 6 classes each semester and complete 8 semesters to graduate grades 9-12
(note, this applies to students who complete all 4 years with JIA)
Recommended Course Schedule (these are your online courses):
Course Credit Provider Target Date of Completion
Assign and meet with the mentor teacher.
Mentor Teacher: _________________________________ Weekly Contact Arrangements (time/location)
Phone Number: __________________________________ ________________________________________
________________________________________
________________________________________
________________________________________
______________________________________________________________ __________________
Name and title of person completing this form Date
JPS / JENISON INTERNATIONAL ACADEMY STUDENT ENROLLMENT FORM
Child’s Legal Name___________________________________________________________________________ Grade _______________ (as shown on birth certificate) Last First Middle
Gender ______ Nickname __________________ Date of Birth _________________ City of Birth ______________________________
Address _____________________________________________________ City _________________________________ Zip ___________
Home/Main Phone _______________________________ Resident of JPS District? Yes / No – Which district? ___________________
Family Email __________________________________________________________________
Previous School Name & Address: _______________________________________________________ Phone: ______________________
Ethnicity – Is this student Hispanic/Latino? (choose only one)
No, not Hispanic/Latino
Yes, Hispanic/Latino (A person of Cuban, Mexican, Puerto Rican,
South or Central American, or other Spanish culture of origin,
regardless of race.)
Race – The question to the left is about ethnicity, not race. No matter what you selected,
please continue to answer the following by marking one or more boxes to include what you
consider your student’s race to be. (Required to meet state reporting guidelines.)
American Indian/Alaska Native Asian American White
Native Hawaiian/Pacific Islander Black/African American
Has your child ever received Special Education services? Yes No
Current Services Provided w/IEP: Special Education – Primary Disability _______________ Class Type ____________________
Speech Occupational/Physical Therapy Social Worker Section 504 Other: _____________
Speaks English? Yes No What is the primary language you use when speaking to this child? _______________________
Medically Diagnosed/Physician Treated Conditions: (include only those conditions that are under a doctor’s care)
_________________________________________________________________________________________________________________
Will prescribed medication be required at school? Yes / No
If yes, medical forms can be obtained from the school office and must be completed before medication can be administered.
Family Physician: ___________________________________________________________ Phone: ________________________________
Hospital or Health Care Facility preferred: ______________________________________________________________________________
I authorize Jenison Public Schools to share medical information about my child with staff members that are in contact with him/her.
_________________________________________________________________________________________________________________ Signature (Legal Parent/Guardian) Date
Parents/Guardians Residing in the Home
Name Name
Relationship Relationship
Employer Employer
Work Phone Work Phone
Cell Phone Cell Phone
Is either parent currently actively serving in the military? No Yes Which branch? ______________________________
Additional Emergency Contacts (if parents cannot be reached):
Name Relationship to Student Daytime Phone
List other children in the family who are attending Jenison Public Schools:
Name Birthdate Gender Grade School
Parents/Guardians Living Elsewhere: (circle one) Joint Custody / Non-Custodial
Name Name
Relationship Relationship
Address
City, St Zip
Home Phone Unlisted? Yes / No
Employer Employer
Work Phone Work Phone
Cell Phone Cell Phone
E-mail E-mail
May we contact Non-Custodial parent in case of an emergency? Yes / No
May we send copy of Report Card (and other school mailings) to Non-Custodial family? Yes / No
If you answered “No” to either of these questions, please attach legal documentation specific to this child as well as legal documentation
specific to communication with the Non-Custodial parent.
Please Read and Sign:
Information on this form will be kept confidential and released only according to the Family Educational Rights and Privacy Act.
In order for a student to enroll in Jenison Public Schools, the parents or guardians must comply with the State of Michigan General School
Laws, which require that students attend school in the district in which they live, with the exception of School of Choice approval or
enrollment in a valid Seat Time Waiver program. If it is found that a student’s documents have been falsified to establish residency, that
student will be immediately dismissed from school, in accordance with district policy.
In order to affirm this student’s residency, I declare that this student physically resides at the address shown. I have presented documents to
Jenison Public Schools confirming the parent/guardian’s name and address and declare that these documents are true and accurate. I am also
aware that deliberate falsification of any information relating to school enrollment is unlawful and will result in the student’s immediate
dismissal from Jenison Public Schools.
_________________________________________________________________________________________________________________
Signature (Legal Parent/Guardian) Relationship to Student Date
Jenison Public Schools does not discriminate on the basis of race, color, religion, sex, national origin, age, height, weight, marital status, handicap, disability,
or limited English proficiency in any of its programs or activities. The following office has been designated to handle inquiries regarding the
nondiscrimination policies: Director of Personnel/Student Services, Jenison Public Schools, 8375 20th Ave., Jenison, MI 49428, (616) 457-8839
OFFICE USE ONLY
_____ Birth Certificate _____ Excel “Board” UIC # _________________________ Date Entered _______________
_____ Imm Record _____ PowerSchool
_____ Residency Verified _____ MCIR Student # _______________ School Entered _______________
_____ SOC Student _____ App Rec’d _____ Transportation
_____ Health Form ____ H ____ V _____ Pupil Accounting Home School _______________ Grade Entered _______________
_____ Records Requested _____ Food Service
Jenison International Academy
Student Permissions
Student Name __________________________________________________________
Directory Information:
Various types of communication materials are produced and published in the school district each year. Examples
include: newsletters, telephone directories, athletic and fine arts programs, press releases, district and teacher
website, etc. These published items may contain specific information and photographs of students.
In accordance with the Family Educational Right to Privacy Act, the following student information has been
designated as directory information. This data will not be released to businesses or organizations for the purpose
of surveys, marketing or solicitation unless the use is consistent with the educational mission of the Board and
beneficial to the student.
Student’s Name Major field of study Scholarships
Address Dates of attendance Participation in officially recognized activities & sports
Phone number Date of graduation Height and weight, if member of an athletic team
Date and place of birth Awards received Name of last previous school attended by student
School sponsored photos Honor rolls
Please indicate your preference concerning the use of directory information by checking one of the statements
below:
The above designated directory information concerning my child may be used in JPS
publications. Yes ____ No ____
My child’s Name, Address and Phone Number may be included in their building’s
student directory. Yes ____ No ____
Pesticide Prior Notification:
You will receive advanced notice of the application of a pesticide, other than a bait or gel formulation at your
child's school. This advance notice of the application will be given 48 hours before the application. The law
requires us to do this notification by using two methods. The first method required by the law is the posting at
entrances to your child's school. The second method we are going to use is the posting on the district’s website.
Parents are also entitled to receive this notice by first-class United States mail postmarked at least 3 days before
the application. If you would like to be notified by mail please contact your child’s school secretary.
Permission for Field Trips:
My child has permission to participate in group field trips away from school during school hours, where such trips
have been planned as part of regular school program. Yes ___ No ___
Parent/Guardian Signature: _________________________________________ Date: _____________
I will notify the school secretary in writing if any of the information contained on this form should change at any time
during the school year.
Jenison International Academy
Student Residency Questionnaire
This questionnaire is intended to address the McKinney-Vento Act 42 U.S.C. 11435. The answers to this
residency information help determine the services this student may be eligible to receive.
Name of Student _____________________________________________________________________
Birthdate ____________________________ Gender ________________ Grade _________________
Name of Parent(s)/Legal Guardian(s) _____________________________________________________
Address ____________________________________________________________________________
City _________________________________ Zip __________ Phone _________________________
1. Is your current address a temporary living arrangement? Yes No
2. Is this temporary living arrangement due to loss of housing, Yes No
economic hardship, or other similar circumstances?
3. Are you a refugee/migrant? Yes No
If you answered NO to the above questions, simply sign and date the bottom of the form.
If you answered YES, please complete the remainder of this form.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Where is student presently living?
In a motel.
In a shelter or other transitional housing.
In a car, park, campground, public space, abandoned building, or substandard housing.
Moving from place to place.
With more than one family in a house or apartment. Who residing with? __________________
With an adult that is not a parent or legal guardian. Who residing with? ___________________
Alone without an adult. Who residing with? ___________________
In Foster Care. Date of placement? ___________________________
Other (please explain) __________________________________________________________
____________________________________________________________________________________ Signature of Parent/Legal Guardian/Person Enrolling Student Date
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - OFFICE USE ONLY - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
______ Powerschool ______ Food Service ______ Transportation _____________ Building Placed
Jenison International Academy Parental Authorization for Release of Records
Last School Attended: ________________________________________________________________________
Street Address: ______________________________________________________________________________
City/State/Zip: ______________________________________________________________________________
School Phone #: __________________________________ School Fax #: _____________________________
In accordance with the Family Educational Rights and Privacy Act of 1974 and Michigan State Law, I hereby
authorize the release of all school records to Jenison Public Schools for the following student:
Name _______________________________________________ Birthdate ______________ Grade ___________
The above named student has enrolled at Jenison Public Schools. Please forward the following information to the
address listed below:
Cumulative Folder (CA60) including all medical records, attendance, discipline and confidential
information.
Records including any psychological evaluations, social work evaluations, copies of IEP’s and MET’s
and any other records applicable to special education placement.
Student UIC number.
Please fax the following information: ____________________________________________________________
According to the Parents Rights and Privacy Act, Section 438, parents or guardians of a student may inspect the
records transferred and request a hearing to challenge the contents therein.
___________________________________________________________ __________________________
Signature of Parent/Guardian Date
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PLEASE FORWARD RECORDS TO:
Rebekah Redmer, Director
Jenison International Academy
2140 Bauer Rd.
Jenison, MI 49428
Phone: 616-457-3400, x-3365
Fax: 616-457-8441
Non-Resident Enrollment Application
Student Name
Address
City/State/Zip
Parent/Guardian
Primary Phone
E-Mail/Secondary Phone
School District You Live In
District & Building Student Currently Attends Current Grade
Student’s Birthdate Grade Requested Desired Date for Enrollment
Building Requested Special Education Needs? _____________________________________
Does student have brothers/sisters enrolled in this district? If yes, list name, school, grade
Reason for Changing School Districts
Please indicate if this student has been:
Suspended Date/Reason/District
Expelled Date/Reason/District
Truant Date/Reason/District
Please review information on the back, then read and sign below: This district does not discriminate on the basis of race, color, disability, religion, gender or national origin. The district reserves the right to limit enrollment based on capacity of buildings or programs as well as failure of applicant to meet any special requirements for entry into its buildings or programs. Enrollment may also be denied to a student who has been suspended or expelled from their previous district or convicted of a felony and to a Special Education student wishing to enroll under Section 105c for whom a written cooperative agreement regarding costs cannot be obtained with their district of residence. I understand these limitations and certify that the information provided on this application is true and complete to the best of my knowledge. I understand the enrollment requirements that pertain to my student as outlined on the back of this application.
Parent/Guardian Signature Date
For District Use Only
Non-Resident Category under which Student is Enrolled & MSDS Code
Bolded categories must have signed release
OAISD Choice Program * (06) Section 105 Schools of Choice (02) Section 105c Schools of Choice (03) Resident District Release * (06) Special Education Ctr Program (06)) Alt Ed Prgm (Cooperative) (06) Alt Ed Prgm (Non-Cooperative) (06) CTE/Vocational Program (06) Non-Public School Student (04) Home Schooled Student (07) Non K-12 District (01) Inter-District Split Student (06) Child of District Employee (06) Other Section 6 Categories (06)
* Resident District Release
Resident District Release
OAISD Choice Program
This student is released for enrollment into another school district.
Releasing School District
Authorized Signature
Date
Student Enrollment Status Enrollment Approved
Building Grade (Note: If Sec 105c Sp Ed Student, an agreement has been executed with the resident district.)
Enrollment Denied for the Following Reason: Authorized Signature Date Received
Date Notified
Submit Application to: Lorri Gierman
Jenison Public Schools 8375 20th Ave.
Jenison, MI 49428
Phone: 616-457-8839 Fax: 616-457-8898
Non-Resident Category – Description & Guidelines OAISD Choice Program ● Application/enrollment period throughout school year ● Continued attendance confirmed annually ● Release obtained annually from district of residence ● District not required to provide transportation ● Program not advertised ● Districts not required to release more than 5% of previous year enrollment to other OAISD schools. Section 105 Schools of Choices – Districts within Intermediate School District (Release from Resident District Not Required)
● Open slots (limited or unlimited) advertised ● Applications accepted only during advertised periods ● Deadline for enrollment once notified of acceptance ● District may deny enrollment to suspended or expelled applicants ● Continued attendance may be confirmed annually ● Annual reapplication not required ● District not required to provide transportation. Section 105c Schools of Choices – Districts within Contiguous Intermediate School Districts (Release from Resident District Not Required) ● Open slots (limited or unlimited) advertised ● Applications accepted only during advertised periods ● Deadline for enrollment once notified of acceptance ● District may deny enrollment to suspended or expelled applicants ● Enrolling district and resident district must execute agreement regarding costs for Special Education students ● Special Education students without agreement may not be enrolled ● Continued attendance may be confirmed annually ● Annual reapplication not required ● District not required to provide transportation. Resident District Release ● Student must be released from district of residence to claim in membership ● Release obtained annually from district of residence ONLY if resident district specified release was only for one school year ● District not required to provide transportation. Cooperative Education Programs - See List Below ● Programs operated under written agreement between districts ● Provides specific type of educational programs ● For students in specifically identified districts ● Cooperative agreement is approval to count the non-resident student in membership; individual student release not required ● Agreement may address transportation issues.
Examples of Cooperative Education Programs that May Fall Within Above Guidelines ● Special Education Center Programs ● Alternative Education Programs ● Career & Technical Education/Vocational Programs ● Non-Public Education for Non-Essential Electives ● Non K-12 Districts
Alternative Education Program – Not Part of Cooperative Multi-District Program ● Student must be released from district of residence to claim in membership UNLESS student meets one or more of following: (1) suspended or expelled from district of residence for any reason; (2) previous drop out from school; (3) pregnant or a parent; (4) referred to program by court; (5) program is alternative or disciplinary education program per section 25.
Split Schedule Students ● Student enrolled in both resident and non-resident district ● Not under cooperative agreement ● Membership FTE claimed at both districts ● Resident district release not required if FTE at non-resident district one-half or less of total FTE ● District not required to provide transportation. Child of District Employee ● Employee’s children may be enrolled without release from resident district ● District not required to enroll ● Board policy should exist ● Tuition may not be charged ● Reported as non-resident ● District not required to provide transportation. Other Section 6 Categories - Non-Resident Students That May be Enrolled Without Resident District Release ● Victim of Criminal Sexual Assault/Serious Assault at resident district ● Student whose district of residence changes after fall count day but prior to supplemental count day and who continues to be enrolled on supplemental count day as a nonresident may be counted without release from resident district. (Reported as non-resident). ● Student receiving ½ or less of instruction in non-resident district. ● Expelled student denied reinstatement by expelling district and reinstated by another district under Section 1311 or 1311a. ● Non-resident student enrolled in program described per section 64 and resident district and enrolling district within same ISD. ● Non-resident student enrolled in United State Olympic education center. ● Non-resident student enrolled pursuant to section 1148(2) of revised school code, MCL 380.1148. ● Non-resident student enrolled as result of resident district not making AYP under NCLB Act of 2001. May 2011
