Olfen Independent School District Application for Transfer for a Non-Resident Student

A separate form is required for each student. If you have questions or need assistance, please call (325) 442-4301.

Student Information

Full Name: ____________________ Grade: _______ _

Date of Birth: ____________ Social Security#: __________ _

School student last attended: ______________ Phone: ______ _

Parent Information

Parent/Guardian name (print please): ____________________ _

Street address:�-----------------------------

City, State, Zip Code: ___________________________ _

Home Phone: _______________ Cell Phone: __________ _

School district in which you/student reside: __________________ _

Reason for transfer request: _______________________ _

Student's Attendance/Behavior Record/Academic Abilities (Estimates are Acceptable)

• How many days was the student absent in the school year prior to the year for which the transfer isrequested? ___ _

• If this request is for transfer during the current school year, how many days has the student missed inthe current school year? __ _

• If the student has missed more than ten percent of the days in the school year, please provide anexplanation: ______________________ _

• Has the student been expelled or removed to DAEP for one or more days in the most recent or precedingschool year? YES __ NO __

Jf YES, for what offense(s)? _____________________ _

I understand that I must provide a copy of prior year's "Report Card and applicable Test Scores (STAAR,ACT/SAT, and/or TSI) before application is complete. Initials ____

OLFEN ISO Registration Fonn for School Vear 2018 • 2019

Campus Name: OLFEN 150 Campus Phone: (325) 442-4301 Campus Fax: {325) 442-2133 STUDENT INFORMATION

D Hispanic D Paci�c Islander Locaf io Student Name Grade level Orig Entry Dt Track SSN

D Whrte □ Black

Gender Date of Binh Birth Place Age (Sept 1st, 2017)D Asian □ American Indian

Address: Student Home Phone: Mailing Address: Student Cell Phone! Student Email: Will your child be using bus transportation lo get to school? D YesD No

PARENT INFORMATION 1. Guardian: Relation: 2. Guardian: Relation:

Address: Address:City, St, Zip: City, St, Zip:

Employer: Employer; Cell Ph: Home Ph: Bus Ph: Cell Ph: Home Ph Bus Ph·

Other Ph: Phone Pref: D Cell□ Home D Business D Other Other Ph: Phone Pref. D Cell□ Home □ Business D Other Receive Mallouts: D Yes D Nolanguage Prel; 0 English D Spanish Receive Mailouls: D Yes□ No Language Pref. D English D Spanish Emergency Contact: 0 Yes D No Email: Emergency Contact: D Yes D No Email. Svc Branch: Rank: Enrolling Person: _ Svc Branch: Rank. Enrolllng Person:_ Righi to Transport: D Yes D No Driver License #: State: Right lo Transport: D Yes D No Driver License #, State:

-

Vehicle Make: Model: Color: Vehicle Make: Model: Color. Vehicle Plale #: Slate: Vehicle Plate #: Slate:

EMERGENCY CONT ACT INFORMATION 1. Name: Relation: Cell Ph: Home Ph: Bus Ph:

Other Ph: Phone Pref: D Cell D Home D Business D Other Right lo Transport: 0 Yes O No Dnver Lrcense #: State: Vehicle Make: Model: Color: Plale#: Slate:

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2. Name: Relalion: Cell Ph: Home Ph: Bus Ph: Other Ph: Phone Pref: 0 Cell O Home D Business D Other Righi to Transport: D Yes D No Driver License #: State Vehicle Make: Model: Color: Plate#: State:

--

Doctor: Bus Ph: Oentisl: Bus Ph: Hospital: Bus Ph: Other Medical: Bus Ph:

Lisi any Allerg,as: SIBLING INFORMATION

Brothers/Sisters Grade School BrolhersISislers Grade School

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The above Information Is required for a permanent school record of your child and will be used by school personnel. Presenting false documents, records or Information Is a vlolatlon of state law and may subject you to tuition cost for your child. I certify that the information given above Is correct. I authorize the school to contact the person named on this form and the above named physician to render such treatment as may be necessary In an emergency of said child. In the event parents, physician, or other persons named cannot be contacted, school officials are hereby authorized to take whatever action Is necessary In their Judgment for the health of the above child, I wlll not hold the school district financially responslble for emergency care and/or transportation.

Parent or Guardian Signature Date of Birth Cate

(For Office Use Only) Teacher Name: Control Nbr:

--

Eligibi�ly Code: _ Birth Certlficale on File: Mil Conn: Foster Care: Immunization on File: TIiie I:

--- - --

Soc Sec Copy on File: __ Al Risk: Migrant:_ Hm Lng: Gift: LEP: BIL: ESL: Par Per: Econ: Special Education: Prim: _sec:_Tert: _ Multi:_

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Qualification for Compensatory Education Funding 2018 -2019 School Year

Olfen ISO may qualify for additional funding from the state if any of our students meet certain guidelines. The additional funding, known as the Compensatory Education Allotment, Is used to provide supplemental services to students who are at-risk or not performing at an appropriate level. Please help us collect the necessary Information so that we may receive additional state dollars for the benefit of our students. The district is automatically eligible for this funding if you receive food stamps or Temporary Assistance for Needy Families (T ANF). Otherwise, the district may qualify for this funding depending upon your income and family size. Please complete the attached Form for Compensatory Education Funding Qualification and return it to your child's campus.

Please complete a separate form for each child. Attached are more detailed Instructions to help you fill out the form.

• Households receiving food stamps or Temporary Assistance for Needy Families (TANF):Complete the child's name and case number and have an adult household member sign theform. If you have more than one child attending school, complete a separate form for each child.

• Households with one or more foster children. List the child's name and the amount of•personal useu income the child received last month and have an adult household member signthe form. If you have more than one foster child attending school, complete a separate form foreach one.

• Households that do not receive food stamps or TANF: If you do not have a case number,you should list the names of all household members, the amount of income each personreceived last month, and where the income came from. An adult household member must signthe form and include his or her social security number or indicate that he or she has no socialsecurity number. If you have more than one child attending school, you should complete aseparate form for each one, but you only have to complete this section once.

SF-141R08

Confidential

Information Olfen ISO

Cempansatery Educalien Funding Quallflcatlen Scheel Year 2018-2019

Confidential

Information

Please till out one form lor each child anendlng school, sign each form, and return II to the office. lnslrucUons for f�llng oul the form are attached.

1. Child's name: _________________________________ _(Last Name) ( First Name, (Mfdd/e /nit/al)

Child's grade: __ _ ___ _ School; ________ _ SSN or student ID: _______ _

2. Is the child a foster chlld? VES _NO __

(Optional)

II VES, list the child's monthly personal use Income; s __________ , then SKIP secUons #3 and #4 and GO TO section #5,

3. Are yo u receiving food stamps or TAHF benefits for your child? VES_NO_ II YES, list the lood Slamp tase number: ______ fTANF case numbar. ______ , lhen SKIP section #4 and GO TO section 15

4, All olh•rhounholds Ccn,plele lhls sedion ii lhe child iS NOT a lgstar dlild and you araNOT 111c11iving lood stamps or TANF benerits IOflha child (l'OU did nOI complete stlClions 12 or #J) (It you have mont Chan one child anencSng school and you are camplellng a separate larm tor each, you may complete this section only once)

Lisi all household members lncludinQ the child listed above Show all Income lhen GO TO secuon #5 NAMES CURRENT MONTHLY INCOME

Monthly earnings Monthly Monthly earnings Check If Monthlywellare, payments fromName of household members so

(before chlld support, pensions, from Job #2 or any (Include the chlld listed above)

Income deductions) allmony retirement, social other monthly

Job#1 security Income 1. s s s s

2. s s s s

3. s s s s 4. s s $ s

5. s s $ s 6. s s s $ 7. s s s s B, s s s s

9. s s s s 10 s s s s

5. Signature and soclal security number. I certify lhat all of the sbovs Information Is tros and correct and that the food stamp or TANF CSSB numbflr Is cummt and com,ct or that all inc:oms Is n,portsd. I understand lhat lhls lnfonnstion Is bf/Ing givsn In order for the school lo receiveadditlonsl stale funding and that school otr,clals may verify the lnfonnal/on.

Signature cl adult ___________________ Social security number ___________ _ Printed name _____________ Home phonfl ________ Workphon e ________ _ MalNng address. _____________ Clly _______ Slale __ ll_Zip ___ Data. ____ _

6, Consent for releaH of lnfonnaUon to Texas Education Agency for program audit purposes. f consBnt to lhs reluss o/ the abovsInformation by 0/fen /SD lo the Texas Education Agency for the purposes o/ auditing compensata,y education funding reports. I understand that the Texas Education Agency will nol share ths information with any otha, entity or program. I also understand lhal lhs /allure lo sign this conssnt does not affect my child's sllglbl/Jty for frae or r.ducedprlcs meals or free milk.

Slgnature rJ adult. ______________ Date _____ _

FOR OFFICIAL USE ONLY: Total Montl1y Income s _____ _ Household Size __

Food Stamp or TANF EMgible [ I

Income Ellgll:lle I IDetermining OfflClal _________ _ Signature __________ _ Date ______ _

SF-141

SF-141R08

OLFEN INDEPENDENT SCHOOL DISTRICT

1122PR2562

RY#�

Gabriel Zamora, Superintendent

MEDIA RELEASE FORM

2018-2019 SCHOOL YEAR

Olfen ISO may highlight the activities of the school and our students in a variety of ways, induding the school district's website; in the classroom/halls; Mustang Message; the school's social media outlets and brochures. These may be used to promote student academic success and extracurricular activities. In these promotions, we may use the students' names and images and samples of their work. These may lndude artwork, projects, photos taken by the student, photos of the student or other academic or creative work. Toe district may, also, wish to publish or display original video or voice recordings.

The district agrees to use these student works and information only in the manner described above.

If this form Is not returned, it will be regarded a ''consent'' by our office. If you have questions or concerns, please call 325-442-4301.

Please check one of the options below, sign and date.

I, being the parent or guardian of-------------' a student of Olfen ISO, hereby:

Consent Do not consent

Parent Signature Date

OLFEN INDEPENDENT SCHOOL DISfRICT

1l22PR2562

fb::re J'.5442.-4301

Dear Parent or Guardian:

Gabriel Zamora, Superintendent Rom:m, 1X 76ffl5

F.rt 32>442-1133

To comply with Texas State Law, the following restrictions apply to administering medications to students at school:

1. All medications, brought to school, must be kept in the AdministrativeOffice. The only exception is an Epi-pen, which may be kept in theclassroom.

2. Prescription and non-prescription medications (OTC pain medications, coughdrops, etc.) must be in the original container. Prescriptions must be in thepharmacy container and display the pharmacy label that includes the name ofthe student. Non-prescription medication must be marked, on the originalcontainer, with the name of the student.

3. All medication must be accompanied by a signed "Authorization ForDispensing Medication" form from the parent/guardian and/or doctor withdirections as to how the medication is to be administered by authorized schoolpersonnel including the time and correct dosage. These forms are availablein the school office.

4. School personnel will not administer any medication unless it isprovided, in the appropriate manner, as stated above.

These restrictions are necessary for the protection of the health and safety of your child. We appreciate your cooperation in this matter.

Sincerely, Gabriel Zamora Olten IS□ Superintendent