James Irwin Charter Schools

Character Development and Academic Excellence

5525 Astrozon Boulevard, Colorado Springs, CO 80916 | TEL (719)302-9000 | FAX (719)576-8071

www.jamesirwin.org

Admissions Packet Student Name: _____________________________________________________ Grade Applying For in 2017-2018: _______________ School Applying For: ______________________________________________ Please complete and turn in the Admissions Packet along with the required documents to the Admissions Office using one of the following methods:

Email to enroll@jamesirwin.org

Fax to (719) 576-8071

Mail to 5525 Astrozon Blvd. Colorado Springs, CO 80916 – Attention – Admissions Dept.

In Person – The Admissions Office is located on the south side of the Astrozon campus in the high school building.

Required Documents to be turned in with Admissions Packet -

1.Birth Certificate

2.Shot Record

3.Latest Report Card - Transcript for high schools students

4.Attendance Report from current school

5.Discipline Report from current school

6.Copy of Parent/Guardian State/Government Issued ID

7.Copy of IEP/504/ELP (if applicable)

We must receive ALL of these documents in order to proceed with the admissions process. ALL forms must be completed in their entirety and signed.

Parental Notification Student Name: _____________________________________ By law, if parents are legally separated or divorced, each parent has equal rights to the custody of the child UNLESS parent has a court order that indicates which parent has custody of the child. The school MUST HAVE A COPY OF THE COURT ORDER ON FILE. Otherwise, either parent may check the child out of school with proper identification. By law, only legal guardians may have access to student information. Any other family member or person acting on behalf of the legal guardian must provide a copy of court documents, power of attorney or other acceptable legal documentation stating that they are authorized to have access to the student’s information and/or make educational decisions for the student. The school MUST HAVE A COPY OF THE LEGAL DOCUMENTATION ON FILE.

I have read the above statements of the law.

______________________________ _____________

Parent Signature Date

This form must be signed and included in every student’s file!

Parent/Guardian Information Parent/Guardian Name: _________________________ Relationship to Student: __________________

Phone Number: __________________________ Email: ________________________________

Parent/Guardian Name: _________________________ Relationship to Student: __________________

Phone Number: __________________________ Email: ________________________________

Emergency Information (non-household members)

First Contact Name: ____________________ Phone Number: _________________

Second Contact Name: __________________ Phone Number: _________________

Required State Information

Student Name:

_ Grade:

1. Birthplace: City State Country 2. If your child was born outside the United States, when did they enter the US? / / 3. Has your child ever been retained? Y or N . If yes, what grade?

The state of Colorado needs accurate information on your student’s standardized testing locations. JICS requires the following information on your student’s schooling from Kindergarten through their current grade. Please state where they lived and where they went to school including the district in which they lived up to the present.

Grade State or Country School Name or Homeschool District # Pre-School (if attended)

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

7th Grade

8th Grade

9th Grade

10th Grade

Admissions Department Revised June 15,2015

James Irwin Charter Schools Character Development and Academic Excellence

Is either Parent active duty military? Do you live on a military base? Y /N

Father – Branch of Service

Mother – Branch of Service

Special Concerns Questionnaire

Student Name: _____________________________________ Grade: ______________

My student ___is / ___is not receiving ESL services (English as a Second Language). Failure to disclose this information may lead to the forfeiture of your student’s spot/enrollment at JICS. _______ (Parent Initials) My student ___ is / ___is not receiving special education services. I understand that a staffing may take place for any student receiving services before a change in attendance can occur. I further understand that it is my responsibility to provide JICS with a copy of the most recent IEP in place at the time my enrollment paperwork is turned in. This enrollment is conditional pending staffing outcomes. Failure to disclose this information and provide the necessary documentation may lead to the forfeiture of your student’s spot/enrollment at JICS. _______

(Parent Initials)

My student ___ does / ___does not have a 504 plan. I understand that a staffing may take place for any student receiving services before a change in attendance can occur. I further understand that it is my responsibility to provide JICS with a copy of the most recent 504 plan in place at the time my enrollment paperwork is turned in. This enrollment is conditional pending staffing outcomes. Failure to disclose this information and provide the necessary documentation may lead to the forfeiture of your student’s spot/enrollment at JICS. _______ (Parent Initials) My student ___ has / ___ has NEVER received services for an IEP/504/ELLP. If student has previously received any of these services: Date my student was staffed out. __________________Copy of document required. My student ___has / ___has not had discipline issues. This enrollment is conditional pending the receipt of discipline records from your child’s previous school. Failure to disclose this information and provide the necessary documentation may lead to the forfeiture of your student’s spot/enrollment at JICS. _______ (Parent Initials) By my signature below, I am acknowledging that I have read, understand, and have carefully and correctly responded to the requested information. I further understand that failure to disclose all the requested information on this page may lead to the forfeiture of my student’s spot/enrollment at JICS. _____________________________________ Signature of Parent/Guardian

Admissions Department Revised February 29, 2016

Home Language Identification Form This form is required for each new student registering at James Irwin Charter Schools.

Date____________________________

Student’s Name ______________________________________________________M_______F______

School __________________________________________Teacher ______________Grade _________

Parent or Guardian’s Name______________________________________________________________

Address _________________________________________________Telephone No.________________

Apartment Name__________________________________ Student’s Date of Birth __________________

Federal and State regulations require schools to determine the language(s) spoken and understood by each student. Thank you for providing this important information.

1. Did your son/daughter learn to speak another language before he/she learned English? ______Yes ______ No 2. How often is a language other than English used in your home? (CIRCLE ONLY ONE)

a. Only the other language and no English. b. Other language more often than English. c. Other language and English equally. d. English more often than the other language. e. Only English.

3. Please describe the language spoken by your son/daughter. (CIRCLE ONLY ONE) a. Speaks only the other language and no English. b. Speaks mostly the other language and some English. c. Speaks the other language and English equally. d. Speaks mostly English and some of the other language. e. Speaks only English.

4. Please describe the language understood by your son/daughter.(CIRCLE ONLY ONE) a. Understands only the other language and no English. b. Understands mostly the other language and some English. c. Understands the other language and English equally. d. Understands mostly English and some of the other language. e. Understands only English.

5. If your son/daughter speaks or understands a language other than English, what is the language? _______________________

6. What language should the school use to communicate with you? _________________

Parent or Guardian’s Signature

COMMENTS:

MIGRANT EDUCATION PROGRAM

(Agricultural Work Survey)

South Central BOCES 323 South Purcell Blvd. Pueblo West, CO 81007

Phone: (719) 647-0023. Fax: (719) 647-0136 www.sc-boces.org

For  More  information  contact: Wilfredo Gutiérrez, 719-641-0156

Have you lived at your present address for less than 3 years? Yes □ No □  Have your children switched school districts in the last 3 years? Yes □ No □ Have you or anyone in your family sought agricultural work? Yes □ No □  Have you or anyone in your family ever worked in farming, planting or harvesting fruits /vegetables, meat and food packing plant, slaughter, dairy farm, poultry, ranching, greenhouses or any other employment related to agriculture or fishing? Yes □ No □    Parents/Guardians Names: ________________________________________________ Address: ____________________________________________ Apt #: _____________ City: ______________________________________ Zip Code: ___________________ Telephone #: ____________________________ Best time to call: _________________    

Please list all children in your home from birth to 21 years

 Name & Last Name Date of

Birth Age Grade School

You and your children might be eligible for the benefits of the migrant education program Please return this form to the school, school district or educational recruiter