Student Enrollment Information

Milton High School 13025 Birmingham Highway

Milton, GA 30004 Phone: 770-740-7000 Fax: 770-667-2888

o Required Paper work from previous school:

WITHDRAWAL FORM (Unless transferring during the summer)

COPY OF TRANSCRIPT (With complete mailing address of school last attended)

ATTENDANCE RECORD

DISCIPLINE RECORD

o Required paperwork from Parent/Guardian:

o VERIFICATION OF RESIDENCY – Need one document from List A and one document from List B

A. One document must be from the list below with the parent or guardian’s name and current address:

Copy of home mortgage bill

Valid Driver’s License/State ID

Copy of home sale contract

Section Eight/HUD Housing Document

Homeowner’s/Renter’s Insurance registration card

Current bank statement

Current Paycheck

Current HOA Bill

Current Apartment/House Lease

B. One document must be from the list below with the parent or guardian’s name and current address:

Current Water bill

Current Electric bill

Current Gas Bill

o IMMUNIZATION RECORDS - Georgia Immunization Certificate (form 3231 Rev. 7/2014). (contact the North Fulton Regional Health Center at 404-332-1958)

o CERTIFICATE OF VISION, HEARING, DENTAL, AND NUTRITION SCREENING (form 3300 Rev. 2013) (contact the North Fulton Regional Health Center at 404-332-1958)

o SOCIAL SECURITY CARD

o BIRTH CERTIFICATE – state issued (hospital certificates not acceptable)

o PROOF OF CUSTODY- if you are NOT the natural parents (contact the Probate Court at 404-613-7638)

o IEP OR 504 PLAN – if applicable

For School Use:

Entry Date: _____/_____/_____Grade Assigned: _____Homeroom/Advisement: _______

FULTON COUNTY SCHOOLS STUDENT ENROLLMENT FORM

SIS-1 Revised 04/14

FORM #113

(1)STUDENT INFORMATION Print All Information Clearly.

_______________________________________________ _________________________________________ Circle One In This Group: SEX: M - MaleStudent's Last Name First Name Middle Name Generation (ex. JR,III) F - Female

_________________ _____/_____/_____ _____________________________ Is this student Hispanic/Latino? (Choose only one)Preferred Name Month/ Day /Yr of Birth Student's Social Sec. # No, not Hispanic/Latino

Yes, Hispanic/LatinoHome Address: _______________________________________________________________________ Street # and Name P.O. Box if App. Apt. # City Zip +4 What is the student's race? (Choose one or more)

1 - American Indian or Alaska NativeHome Phone: ( ) _______________________ Complex/Subdiv.Name: ______________________ 2 - Asian

3 - Black or African AmericanSchool system of residence if other than Fulton:_________ RESTRICT DIRECTORY INFORMATION? Y N 4 - Native Hawaiian or Other Pacific IslanderCounty of residence if other than Fulton: ________________ 5 - WhiteName of School Serving area in which student lives: _______________

(2)PARENT/GUARDIAN INFORMATION (Complete a box for each parent, step-parent, or guardian; add page if necessary)

Name:__________________________________________ Name:__________________________________________ Name:__________________________________________ Last First MI Suff. Last First MI Suff. Last First MI Suff.Home Address & Phone If Different From Student's Home Address & Phone If Different From Student's Home Address & Phone If Different From Student'sAddress: ______________________________________Address: ________________________________________ Address: ______________________________________City/State/Zip+4: ______________________________________City/State/Zip+4: _________________________________________ City/State/Zip+4: ______________________________________Home Phone: ( ) _________________________________Home Phone: ( ) ____________________________________Home Phone: ( ) ________________________________Alt/Cell Phone: ____________________________________Alt/Cell Phone: ______________________________________ Alt/Cell Phone: ____________________________________Occupation: ______________________________________ Occupation: _________________________________________ Occupation: ______________________________________Business Name: ___________________________________Business Name: ______________________________________Business Name: __________________________________Business Address: ________________________________ Business Address: ___________________________________ Business Address: ________________________________City/State/Zip+4: __________________________________City/State/Zip+4: _____________________________________City/State/Zip+4: _________________________________Business Phone: ( ) ______________________________ Business Phone: ( ) _________________________________ Business Phone: ( ) ______________________________Circle Relation to Student: Mother,Father, Stepmother, Circle Relation to Student: Mother,Father, Stepmother, Circle Relation to Student: Mother,Father, Stepmother,Stepfather, Legal Guardian,Other Stepfather, Legal Guardian,Other Stepfather, Legal Guardian, OtherContact w/student is allowed? Y N Contact w/student is allowed? Y N Contact w/student is allowed? Yes NoResides with this parent/guardian? Y N Resides with this parent/guardian? Y N Resides with this parent/guardian? Yes NoParent/guardian is responsible for student? Y N Parent/guardian is responsible for student? Y N Parent/guardian is responsible for student? Yes NoWorks for federal gov't or on federal property? Y N Works for federal gov't or on federal property? Y N Works for federal gov't or on federal property? Yes NoEmail__________________________________________ Email__________________________________________ Email____________________________________________

(3)MEDICAL/EMERGENCY INFORMATION (4)ENROLLMENT INFORMATIONFamily Physician Has student ever attended a Fulton County School? Yes NoFirst/Last Name: ____________________________________ Physician's Phone: ( )_____________________ext._____ If no, Non-Ful.Co. prior school name: ______________________Insurance/Health Coverage: _______________________________________________________________________ City & State of prior school: _________________________Note medical problems, medication requirements, life-threatening allergies, and other special instructions: Enrolled from ____/____/____ to ____/____/________________________________________________________________________________________ If yes, give name of school(s): _____________________________

____________________________________________________________________________________ y ________________________________________________________________________________________________________________________ Date first entered a USA School (mm/dd/yy) ______________The persons below have authorization to pick-up my child during school hours and can be reached at the numbers listed.FirstName,LastName Phone Number Ext. Relationship Chk out of School? Entry Codes: (Circle One)__________________________ ( ) ________________ ____________ ______________ Y N C Continue in same school W Admitted under SB10__________________________ ( ) ________________ ____________ ______________ Y N U From within system X Admitted under USCO

List Siblings in THIS school: T From another GA public school A From a home school

O From another state or country N Never attended school

(5) REQUIRED INFORMATION P From a private school S Re-entry after illness

Active Military Yes No B Previously WD from this school & year I Re-entry after incarceration

V Admitted under School Choice R Re-entry other

Active Military indicates whether the student has a parent or guardian who is active in US Armed Forces, (6) MANDATORY FOR ALL STUDENTSincluding the National Guard or Reserve Forces. To provide your child with the best possible education, we need to determine

how well he or she speaks and understands English. This survey assists school

(7)FOR SCHOOL USE ONLY personnel in deciding whether your child may be a candidate for additional

Immunization Code (Circle One) Student has met the following requirements: English language support. Final qualification for language support is basedE - Medical Exemption Ear Exam Yes _____ No _____ on the results of an English language assessment.N - GA Requirements Not Met Eye Exam Yes _____ No _____R - Religious Exemption Dental Exam Yes _____ No _____ **Which language does your child most frequently speak at home?

(Primary/Native Language)? ________________________________W - 30-Day, 90-Day, 180-Day Waiver Emer.Sig.Card Yes _____ No _____ **Which language do adults in your home most frequently use when

speaking with your child?Follow-up Date: _____/_____/_____ Birth Certificate Yes _____ No _____ (Home Language)?___________________________________

**Which language(s) does your child currently understand or speak?Y - GA Requirements Met (Correspondence Language) ?__________________________

Has student ever received services in the following programs?High School Course of Study/Graduation Track * Valid only if student entered 9th grade prior to 2009 Gifted Yes No EIP Yes No

Title I Yes No ESOL Yes NoCircle One: **Valid only if student entered 9th grade in 2009 or Remedial Ed Yes No Homeless Yes NoB - Both College Prep. And Career Tech* later 504 Yes NoC - College Preparatory Spec. Educ. Yes No If Yes, Area __________________D - College Prep w/Distinction Date 1st entered 9th grade (mm/dd/yy): ____/___/___ Other Programs (Specify) ____________________________H - Career Tech Prep.**M - College Prep & Career Tech Prep w/Distinction PreK Program Attended: Circle OneN - College Prep w/Distinction & Career Tech. Prep 1. GA PK-Public School 5. Private Non-Profit PKQ - College Prep & Career Tech w/Distinction 2. Public Sponsored PK (Title1) 6. Private For-Profit PKS - Special Education 3. Head Start 7. Did not attend PKU - Career Tech Prep w/Distinction 4. Other Public School 8. GA PK-Private School

Hardship Student (Circle one)

Childcare, Curriculum, Moving,Employee, Medical, Adm.Placement High School Only: I have received a student handbook. Magnet Program Student (Circle one)

Student Signature: Art/Science, Math/Science International Studies, Visual & Performing Arts, International Studies Tuition

PARENT SIGNATURE: ________________________________________________

ENROLLMENT DECLARATION

Milton High School • 13025 Birmingham Highway • Milton, GA 30004 • 770-740-7000

Student Name: ________________________________________________________________________ Last First Middle Date of Birth Grade

Current Address: _______________________________________________________________

Phone Number: ______________________

TO BE COMPLETED BY PARENT:

• Is the student currently on suspension or expulsion from another school or school system? No___ Yes___

If YES, give reason(s): ____________________________________________________________

____________________________________________________________

Terms of Suspension: ____________________________________________________________

____________________________________________________________

• Has the student ever been convicted of a felony crime (armed robbery, aggravated assault or battery, rape,

carrying a deadly weapon, felony drugs, kidnapping, arson, murder, hijacking, etc.)? No___ Yes___

If YES, date of conviction: _____________________________________________________

Offense(s) committed: _____________________________________________________

Name and Location of Court: _____________________________________________________

Sentence Imposed: _____________________________________________________

NOTE: A STUDENT MAY BE WITHDRAWN FROM SCHOOL IF FALSE INFORMATION IS PROVIDED

Georgia Law

If a transferring middle/high school student does not bring a certified copy of his/her academic transcript and

disciplinary record from the school previously attended by the student, a new Georgia law (OCGA 20.2.670)

provides " ... a transferring student may be admitted on a conditional basis if he or she and his or her parent or

legal guardian executes a document providing the name and address of the school last attending and authorizing

the release of all academic and disciplinary records to the school administration ... and … “shall also disclose on

the same document as the release whether the child has ever been adjudicated guilty of the commission of the

designated felony act as defined in Code Section 15.11.27 and, if so, the date of such adjudication, the offense

committed, the jurisdiction in which such adjudication was made, and the sentence imposed … The student or

his or her parent or legal guardian shall also disclose on the document whether the student is currently serving a

suspension or expulsion from another school, the reason for such discipline and the term of such discipline. If a

student so conditionally admitted is found to be ineligible for enrollment pursuant to the provisions of Code

Section 20.2.752, or is subsequently found to be so ineligible, he or she shall be dismissed from enrollment until

such time as he or she becomes so eligible."

_________________________________________ __________________________

Parent Signature Date

Milton High School 13025 Birmingham Highway (770) 740-7000

Milton, GA 30004 Fax (770) 667-2888

www.miltonhighschool.com

REQUEST FOR STUDENT RECORDS

Student’s Name: __________________________________ Date of Birth: ___________

Previous School: __________________________________ Current Grade: ________

School Address: _________________________________________________________

_________________________________________________________

City State Zip Code

The above named student has enrolled in our school. Please forward the following

information to Milton High School:

Official transcript – Please indicate how many points are added to Honors,

AP/IB, and/or College grades

Withdrawal Grades

Explanation of Grading Scale

Immunization Records

Standardized Test Records

Discipline Records

Attendance Records

Special Education Records (including IEP, Psychological and Evaluation Reports)

ESOL records

I Authorize Release of These Records.

______________________________________________

Parent/Legal Guardian Signature

According to the Final Regulations – Family Educational Rights and Privacy Act (Buckley Amendment)

dated June 17, 1976, it is not longer necessary to obtain written consent from parent to release records

between schools. It states that school officials in the school system in which the student may intend to

enroll may receive a student’s records without written consent for such release.

___________________________________________

Records Requested By: Date

INFORMATION FOR GETTING IMMUNIZATION

RECORDS TRANSFERRED TO GEORGIA FORMS

North Fulton Regional Health Center

3155 Royal Drive, Suite 125

Alpharetta, GA 30022

404-332-1958

Hours:

Monday – Friday 8:30 am – 5:00 pm (highly suggested to get there before 2:30 pm)

No Appointment necessary

Services available for a fee

Transfer of immunizations to GA certificate( form 3231 Rev. 7/2014)

Ear, Eye, Dental & Nutritional Certificate (form 3300 Rev. 2013) and Screening

Immunizations

NO SHOTS = NO SCHOOL

Please protect your child against measles, mumps, polio, rubella, whooping cough, diphtheria, hepatitis B

and chicken pox, Meningococcal and Tdap (Tetanus with Pertussis)x. Call your family doctor or the

health center nearest you.

Effective July 1, 2014, all 7th

grade students who were

born on or after January 1, 2002 and for new entrants

grades 8-12 who are entering into a Georgia school for

the first time or entering after having been absent

from a Georgia school for more than twelve months or

one school year will be required to have:

1 Dose of Tdap (Tetanus, Diphtheria, Pertussis

Vaccine)

AND

1 Dose of Meningococcal Conjugate Vaccine

A new Certificate of Immunization Form 3231 (Revised 7/2014) will be

required for students to register for school. The new 3231 Certificate of

Immunization Form will be available and all community providers and

health departments should have access to the form and to GRITS (The

Georgia Registry of Immunization Transactions and Services). Proof of

both vaccinations must be documented on the Georgia Immunization

Certificate (Form 3231).

Certificates issued prior to July 1, 2014 can either be the old form 3231

(Revised 3/2007) or the new form (Revised 7/2014) but it must show proof

of the two vaccinations unless the child has an exemption.

You must check for these vaccines, even if the certificate is marked

complete. If the Certificate is marked complete and the child does not have

these vaccines, he/she must return to his primary care provider or public

health center to receive the vaccines and a new/updated certificate. For more information, visit http://dph.georgia.gov/vaccines-children or call (800)848-3868.

PLEASE NOTE: These changes only affect rising 7th graders (born on or after January 1, 2002),

and students who are considered “new entrants” for grades 8-12.

Georgia Department of Public Health Form 3300

Certificate of Vision, Hearing, Dental, and Nutrition ScreeningFILE THIS FORM WITH THE SCHOOL WHEN YOUR CHILD IS FIRST ENROLLED IN A GEORGIA PUBLIC SCHOOL

SCREENER CONTACT INFORMATION IS REQUIRED

Child’s Name:__________________________________________________ first middle lastDate of Birth: _____/_____/_____ Gender: Male FemaleChild’s Home Address: ____________________________________________________________________________________street city state zipcode county

Parent/ Guardian Name:_______________________________________ first middle lastParent/ Guardian Contact Information: Daytimephonenumber:_____________________________________________________________Eveningphonenumber:_____________________________________________________________Cellphonenumber:_________________________________________________________________

VISIONUnabletoscreen(explainwhybelow)UsescorrectivelensesWornfortesting

Passed(20/30ineacheyeforage6andabove,20/40ineacheyeforbelowage6)

NeedsfurtherevaluationUnderprofessionalcare(explainbelow) Screening completed by:PhysicianLocalHealthDepartmentOptometrist“PreventBlindnessGeorgia”employeeSchoolRegisteredNurse

___________________________________Screener’s Signature DateI certify that this child has received the above screening.Contact Information:

HEARINGUnabletoscreen(explainwhybelow)Useshearingaid/assistivedevice

Passedat500,1000,2000,and4000Hzwithaudiometerat20or25dB

NeedsfurtherevaluationUnderprofessionalcare(explainbelow)

Screening completed by:PhysicianLocalHealthDepartmentAudiologistSpeech-LanguagePathologistSchoolRegisteredNurse

___________________________________Screener’s Signature Date I certify that this child has received the above screening.Contact Information:

DENTALUnabletoscreen(explainwhybelow)

NormalappearanceNeedsfurtherevaluationEmergencyproblemobservedUnderprofessionalcare(explainbelow) Screening completed by:PhysicianDentistLocalHealthDepartmentRegisteredNurseRegisteredDentalHygienistSchoolRegisteredNurse

___________________________________Screener’s Signature DateI certify that this child has received the above screening.Contact Information:

NUTRITIONUnabletoscreen(explainwhybelow)

Height:___________ Weight:___________BMI:_____________BMI%:___________5thto84thpercentile-Appropriateforage<5thpercentile-Needsfurtherevaluation≥85thpercentile-NeedsfurtherevaluationUnderprofessionalcare(explainbelow)

Screening completed by:PhysicianLocalHealthDepartmentRegisteredDieticianSchoolRegisteredNurse

___________________________________Screener’s Signature DateI certify that this child has received the above screening.Contact Information:

FOR SCHOOL SYSTEM ONLY Follow up for further evaluation

1st attempt 2nd attempt Actions reported (if any)VisionHearingDentalNutritionStudent support services initiated on:

Screeners’ Comments:

DPH Form 3300 Rev. 2013

PLEASE SEE THE INSTRUCTIONS ON THE BACK OF THIS FORM

Georgia Department of Public Health Form 3300 Certificate of Vision, Hearing, Dental, and Nutrition Screening

Who is required to file this Form 3300? The parent or guardian of a child who is being admitted for the first time to a public

school in Georgia must file a completed Form 3300 with the school when the child is enrolled.

What is the purpose of Form 3300? Form 3300 is intended to make sure that every child in Georgia is screened for possible problems with their vision, hearing, teeth and nutrition. The earlier these problems are detected, the earlier parents can seek professional help for the child.

What screenings are required? Four different screenings are required: vision, hearing, dental, and nutrition. All four

screenings must be conducted and reported on the form before it can be filed with the school.

Who can conduct the screenings? Your child’s doctor is authorized to conduct all four screenings, as is your local health department. In addition, the vision screening can be conducted by a Georgia licensed optometrist, an employee of Prevent Blindness Georgia trained to conduct vision screening, or a school registered nurse; the hearing screening can be conducted by a Georgia licensed speech-language pathologist or audiologist, or a school registered nurse; the dental screening can be conducted by a Georgia licensed dentist, dental hygienist, or a school registered nurse; and the nutrition screening can be conducted by a Georgia licensed dietician or a school registered nurse. It is not necessary that the same person conduct all four screenings.

What does “BMI” and “BMI%” mean? “BMI” means “body mass index.” BMI is a way to describe how

much a child weighs in relation to height. “BMI percentile” is a way to compare the child’s body mass index to the body mass index of a healthy child. If the child’s BMI is less than 5% or more than 84% of what is appropriate for his or her age and height, then the child should be taken to a doctor or dietician for a more detailed evaluation. For more information, visit the Centers for Disease Control and Prevention website on child and teen BMI at:

http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html What should a parent do if the “needs further evaluation” box is checked? “Needs further evaluation” means that the child may have a problem. If the “needs further evaluation” box is checked, then the parent should

take the child to a professional for a more detailed evaluation. Your doctor or local health department may be able to help, or recommend someone who can help.

What if a Form 3300 was previously filed for the child at another school? It is only necessary to file the Form 3300 once.

If the Form 3300 is filed at the child’s first school, and the child later transfers to another school, then the original school is required to forward the Form 3300 to the new school.

Georgia High School Graduation Test

All Students who wish to graduate from a public high school in

the state of Georgia must pass all five sections of the Georgia

High School Graduation Test (GHSGT).

Mark with an X each section of the GHSGT that you have

passed. We will also need proof of a passing grade, which

should transfer with the records from your previous school.

Science

Social Studies

Mathematics

English/Language Arts

Writing

Or

I have not passed any sections of the GHSGT

Student Signature: _______________________________________

Parent Signature: ________________________________________

Honors Points Added to Transfer Grades

The Q&A on Honors Points and the EOCT includes the following statement about transfer

grades:

Will honors points be added to the grades of students who transfer into Fulton County from other

school systems?

No, the grades of transfer students will be recorded just as we receive them; we will not add

honors points to their honors or AP grades. Many school systems have already added points to

their students’ grades and it is not possible for us to determine who has and has not already

received honors points.

Revision to the Stated Procedures as of 10/15/2004:

Because most systems who weigh honors, AP and IB courses add the points to the grade that

appears on the transcript, we will not add honors points to a transfer student’s grades unless the

parent or guardian produces an official school system document or a notarized statement on

school system letterhead that speaks to how honors points were or are given during the entire

time the student was enrolled in the system. When this documentation is presented, seven (7)

points will be added to each honors, AP or IB course using the same procedures we use for our

students. It is not the responsibility of the counseling staff at the receiving school to seek

information from the sending school about this matter.

If a school system uses a grading scale where a D is a 60-69 and, consequently, credit is

awarded, the seven (7) points will be added to honors, AP and IB courses BEFORE any other

conversion is made. For example, if the student presents a 64, the grade to be recorded will be a

71. If the student presents a 62, adding seven (7) points make the grade a 69 and we convert to a

70 which is the lowest passing grade we can record.

I have read the Honors Points Added Transfer Grades Policy

Sign: __________________________________________ Date: _________________________

GEORGIA HIGH SCHOOL ASSOCIATION TRANSFER STUDENT ELIGIBILITY - FORM B P. O. Box 271, Thomaston, GA 30286 - 706-647-7473 FAX: 706-647-2638

INSTRUCTIONS: This form may NOT be handwritten, and must be submitted for each student who has transferred to your school in the past twelve months from the date of the student transfer. WARNING: Falsification of data on this form may result in institutional penalties such as fine and/or forfeitures of contests. It could result in the student being declared ineligible for any competition for a period of up to two years. It also could result in the transmission of a report of the falsification to the Professional Standards Commission if certified personnel were involved in the falsification.

SECTION A DATE OF THE STUDENT TRANSFER__________________ ACTIVITY ___________________ SCHOOL ____________________________________________ CITY ___________________________ SCHOOL YEAR ____________ ______ In-state Transfer ______ Out-of-state Transfer ______ Approved Foreign Exchange: Program _____________________________ (Complete Section A and B Only)

NAME LAST FIRST MIDDLE

DATE OF BIRTH DATE STUDENT ENTERED 9TH GRADE

UN

ITS

EAR

NED

Pr

ev S

emes

ter

TOTA

L U

NIT

S EA

RN

ED

(This Column for GHSA use only) ELIGIBILITY STATUS Mo. Day Year Mo. Day Year

Beginning & Ending Dates Attended Beginning with 9th Grade (Give month, day, year) Grade Name of School Address (City, State) _____________________________ ___________ ______________________________________ ________________________________________ _____________________________ ____________ ______________________________________ ________________________________________ _____________________________ ____________ ______________________________________ ________________________________________

_____________________________ ____________ ______________________________________ ________________________________________

SECTION B - General Transfer Information

Present Home Address:__________________________________________________ ____________________________________________ (Street) (City, State) (County)

Lives With: ___________________________________________________________ ____________________________________________ (Names) (Relationship)

Previous Home Address: _________________________________________________ ____________________________________________ (Street) (City, State) (County)

Persons Student Lived with at Previous Address: ______________________________ ____________________________________________ (Names) (Relationship)

Is the current residence located in your school service area? __________ Is the custodial parent a certified teacher, counselor or administrator at the receiving school (Grades 9-12)? __________ Was the student suspended or expelled (or facing such penalties) at the former school? (If yes, attach additional information) __________ Does the student qualify for a waiver due to a joint custody or a custody change? (If yes, attach court documents, including judge's signature) __________

SECTION C - Family and Residential Information (Complete only if a bona fide move is claimed)

CURRENT RESIDENCE: Is the current residence being: ______ purchased; ______leased; ______rented? Do you claim multiple residences? ______ If “Yes”, do you claim a Homestead Exemption on this residence? ______ PREVIOUS RESIDENCE: Have you relinquished your previous residence? ______ If "Yes", how was it relinquished? ______ rented previously; ______sold residence or have a contract for sale; ______residence listed for sale at fair market value; ______abandoned the house with unnecessary utilities shut off; ______leased/rented residence at a fair market value. If “Yes”, is the residence being leased/rented to a family member? ______. If “Yes”, please list that individual and relationship: __________________________________________________________________________________________________________. VERIFICATION OF THE BONA FIDE MOVE: (Completed by school personnel) ______Accepted the word of the parent/guardian. ______Conducted a site visit - if "Yes", who made the visit ?_________________ ______Received documentation via utility bill, post office documentation, driver's license, etc. - if "Yes", what document?________________ _________________________________________ ___________________________________ ____________________ (Signed - Principal / Asst. Principal / AD) (Signed – Report Preparer) (Date)

(Revised June, 2012)