Revised 5/1/20

FORT ZUMWALT SCHOOL DISTRICT

ENROLLMENT INFORMATION

Enrollment must be completed by the Parent/Court Approved Legal Guardian

Please submit the required documents to your child’s school.If you are not sure which school your child will attend, please call 636-240-2072.

The following documents are required for each student that is enrolling:

- Proof of Parent/Guardian Identification – Driver’s license or other state or federally issued photo ID that is valid.

- Student’s State Issued Birth Certificate – May be obtained with records from previous school

- Complete Record of Immunizations – Must comply with Missouri state law. May be obtained with records from previous school.

- Custody Papers (Divorce Decree, Legal Guardianship, etc.) – if applicable

- Request for Student Records form – attached

- Quick Registration Form - attached

- Parent Web Access Registration Form – attached

- Language Use Survey form – attached

- Student Transportation Information form - attached

- Statement of Proof of Residency form - attached

- Proof of Residency – See below for requirements.

After submitting these documents, you will be contacted by your child(ren)’s school(s) with your login information to complete

enrollment online.

If you own or lease your own home, one document from each list must be submitted.

List A List B

A Current Rental Agreement

-Must be supplied if renting

-Must be signed by landlord and tenant(s)

Current Bank Statement

Current Mortgage Statement Current Credit Card Statement

If you just purchased a home, recent

ALTA Settlement Statement*

-Must be signed by both parties

Current Loan Statement

Current Gas or Electric Bill

-Mailing & service address must match

Current Water Bill

-Mailing & service address must match

Welfare, Social Security, or Other Official Mail from

Federal and State Agencies

All documents need to be dated within the past 30 days.

* If you moved in the last 2 weeks, a second document from List B will need to be supplied in 30 days.

If you do not own or lease your own home (living with another family, friend, significant other, etc.):

• Both home owner/lessee and parent will need to go to the school to obtain a residency affidavit.

Home owner/lessee will need: Parent / Guardian will need:

Valid Photo ID Valid Photo ID

Current Gas or Electric Bill –

-Dated within 30 days

-Mailing & service address must match

Current Bank Statement, Loan Statement, or Credit

Card Statement – dated within 30 days

* If you moved in the last 3 weeks, the statement will

need to be supplied in 30 days.

**If you are currently residing in a hotel or shelter, contact the Homeless Coordinator @ 636-240-2072 or your child’s school

counselor.

FORT ZUMWALT SCHOOL DISTRICT Honored for “Distinction in Performance” by the State Board of Education

Revised 7/21/20

REQUEST FOR STUDENT RECORDS

Today’s Date: ________________________

Name of Student: _________________________________________ DOB: _________________ Grade: ___________

Last School Attended: _____________________________________ Last School District: _______________________

School Address: _________________________________________ City, State, Zip: ___________________________

School Phone: _____________________________ Fax: ____________________________

This is a request for the specific information checked below:

_____ **Disciplinary Records**

SENDING SCHOOL, PLEASE CHECK ONE

NO – Student did not receive any discipline while enrolled

YES – Student did receive discipline while enrolled. Discipline records are included.

_____ Official School Transcript/Records

_____ Health Records and Immunizations

_____ Individual Educational Program (IEP) and Evaluation

_____ Special Education Progress Reports (Please include IEP and complete diagnostic)

_____ Achievement Test Scores

_____ Assessment Test Scores

_____ Screening Test Scores

_____ Legal Documents Pertaining to Guardianship and/or Parental Rights

_____ Physician's Medical Report

_____ Attendance Records

_____ ESL/ELL/ESOL Records and Scores

_____ Gifted Records and Scores

Other Specific Information: _____________________________________________________________

I give permission for records to be released to ___________________________________ School.

_________________________________________ ______________________

Parent/Guardian Signature Date

The student named above is in the process of enrolling. The Family Educational Rights and Privacy Act (Buckley

Amendment) dated June 17, 1976, states that the signature of a parent or guardian is not required for school records to

be sent to another educational facility. However, when a parent or guardian is available, we do require his/her signature.

Fax or Email Records to: School Name

Registrar Name

Address

City, State, Zip

Telephone #

Fax #

X

XXXXXX

XXX

X

XX

FORT ZUMWALT SCHOOL DISTRICT

QUICK REGISTRATION FORM

STUDENT’S LEGAL NAME:

__________________________ ______________________ ______________________ ___________________

Last Name First Name Middle Name Preferred Name

Date of Birth:_________________ Gender: Male Female Grade:_______________

Home Address:______________________________________ City:______________________ Zip:_____________

Is the student Hispanic/Latino? Yes No

What is the student’s race? (Choose all that apply)

Asian White Black or African American Native American/Eskimo Native Hawaiian or Pacific Islander

Language Spoke in Home: _________________________

PRIMARY HOUSEHOLD

ADULT #1 – LEGAL RELATIONSHIP ADULT #2– LEGAL RELATIONSHIP

Father Stepfather Guardian/Caregiver Mother Stepmother Guardian/Caregiver

Mother Stepmother Foster Parent Father Stepfather Foster Parent

Other/Live-In Companion Other/Live-In Companion

_______________________________________ __________________________________________

First Name Last Name First Name Last Name

Home/Cell Phone:________________________ Home/Cell Phone:____________________________

Email Address:___________________________ Email Address:______________________________

Parent/Guardian with whom student resides

(In 50/50 custody, parent whose address will be used for student. Second household will be entered online.)

If applicable, secondary household information can be completed online.

Is there a divorce decree or parenting plan involving this student? Yes No

Is there a court order other than parenting plan? Yes No Court Order Against: __________________

**Please present a complete, signed copy of any legal documents/court orders pertaining to the student**

(divorce decree, custody, restraining order, etc.) To be submitted at enrollment.

Non-Custodial parents have legal access to a student's records and authority to pick up the child unless custody

paperwork and/or court order is on file stating otherwise.

_______________________________________________________________________ ____________________

Signature of Parent/Legal Guardian Relationship to Student Date

FOR OFFICE USE ONLY

School Year Teacher/HMRM Sub Div Code Start Date

School Counselor Bus # Grade

FORT ZUMWALT SCHOOL DISTRICT

Parent Web-Access Registration Form

For security purposes, you must return this completed form to your child's school in person. You will be asked to

show a photo ID when you register. One parent/guardian (in person) may register additional parents/guardians.

Up to four parent/guardian logins may have access to a student's information. Once you are registered, the

information will be put into our district's student management system at your child's school.

The Parent Web-Access system will then email the registered email address(es) the login password. Your login user

name will be your registered email address. To logon to the parent portal, go to the district website at:

www.fz.k12.mo.us and click on PARENTS, STUDENTS, ALUMNI > Parents > Log-in to the Portal

PLEASE BE SURE TO CLEARLY PRINT ALL INFORMATION BELOW.

Please check the Appropriate Item(s):

I am registering for the first time. _____

Update my information in Parent-Web Access (i.e. new mail account) _____

Add another user to my existing Web Access account _____

Reset my login password _____

Student 1 Student 2 Student 3

Name of School

First Name

Last Name

Birthdate

Grade

Signature and Photo ID are required to register for Parent-Web Access

Parent/Guardian Signature____________________________________________________Date_____________________

FOR OFFICE USE ONLY

Building/Registrar Initials Last 4-digits of ID# Date From To

Identification Verified

Entered into SIS

Revised 6/21/17

School Routing

(PLEASE PRINT ALL INFORMATION)

Student 4

E-mail Address:

E-mail Address:

E-mail Address:

E-mail Address:

Household Parent 1 First and Last Name:

Household Parent 2 First and Last Name:

Nonresident Parent 1 First and Last Name:

Nonresident Parent 2 First and Last Name:

FORT ZUMWALT SCHOOL DISTRICT 555 E. Terra Lane

O’Fallon, MO 63366

Honored for “Distinction in Performance” by the State Board of Education

SCHOOL OFFICE USE

o Copy to ESOL Teacher

o Copy To Bob Hanna FPE

o Copy To Perm File

o Has ACCESS/W-APT ScoreFrom Transferring School

o Needs W-APT Testing

ESOL OFFICE USE Service Deliver Model

o NLP □ AY3

o RCV □ AY4

o NF

o MY1

o MY2

Language Use Survey

Student’s Name: __________________________________________________ Date: _______________

School: ____________________________________Date of Birth: _______________ Grade: _________

Relationship of person completing this survey: ______________________________________________ Tier I: Language Background

1. What was your child’s first language? English Other: ______________2. Which language(s) does your child use (speak) at home and with others? English Other: _________3. Which language(s) does your child hear at home and understand? English Other: _________4. How many months has your child been in the country? ____________If any of these answers indicate a language other than English, please complete the rest of the survey.

Tier II: Expanded Language background Yes No

5. Does the student understand when someone speaks with him/her in a language besides English?

6. Does the student read in a language other than English?

7. Does the student write in a language other than English

8. Does the student interpret for you or anyone else in a language other than English?

The school is required to assess the English language proficiency of all students who indicate, or are suspected of having, a first language other than English. If the results of the assessment show a student needs language support, you will be notified in writing and the school district will provide language support as deemed appropriate by district staff.

Cuestionario del Uso de Idiomas

Notice to School Staff: This form must be given to all new and enrolling students. Any student that indicates use of a

language other than English must be assessed to determine the student’s English language proficiency. Please notify

district staff responsible for the next steps immediately and when ready, keep this form in the student’s permanent

records. Revised 4.2019

Tier III: Educational History

9. How many years did the student attend school where the native language was used for instruction? ________

10. What was the most recent month and year the student attended school? ______________________________

11. Do you believe that your child has learning difficulties that affects his/her ability to understand? ____________

If yes, please explain: _________________________________________________________________________

12. Has your child been referred to be evaluated for special education? If yes, please explain__________________

______________________________________________________________________________________________

In order to provide your child with the best possible education, we need to determine how well he or she

understands, speaks, reads and writes in English. Please provide information about your child’s language

abilities.

School Date

Grade (please circle) K 1 2 3 4 5 6 7 8 9 10 11 12

Student's Name

Home Address

Subdivision/Mobile Home Park

Parent/Guardian Name

Home Phone

Will student ride the school bus Yes No

to and from home?

(Students are automatically assigned to a bus and a bus stop that services their home address.

If the student is going to a babysitter or daycare, the parent is to call the Transportation Dept

(636) 240-3138, to set up the child to ride the bus.)

BUS #

BUS STOP Check if stop needs

to be added

PICK UP TIME

START DATE ON BUS

School needs to inform parents of the bus number, stop and pick up time

Work/Emergency Phone

SCHOOL OFFICE USE ONLY

STUDENT TRANSPORTATION INFORMATION(For Eligible Bus Riders Only)

STATEMENT OF PROOF OF RESIDENCY

I hereby certify as follows:

am the parent/guardian of I, ___________________________________________________

Parent/Guardian

, a student seeking to register in the _____________________________________________

Student

Fort Zumwalt School District, and am legally authorized to make educational decisions for the student.

I further certify that the student is a resident of the district as established by the following: (WARNING: Under Missouri

law, any person who knowingly submits false information with respect to the following questions, any subparts thereto, or

the documents provided to support the responses to such questions, may be charged with and convicted of a Class A

misdemeanor).

The student is a legal resident of the District. In making this statement, I certify that I am a legal resident of the Fort

Zumwalt School District, and I reside and am legally domiciled (have my permanent home) at the following address:

___________________________________________________

Street

___________________________________________________

City, State, Zip

The student resides with me at the foregoing address, which is also the student’s permanent home. I have provided the

following document(s) to establish that I am a legal resident of the District:

(1) _________________________________________________

(2) _________________________________________________

I hereby certify that all information I have provided in this Statement is true, accurate, and complete to the best of my

knowledge.

I understand that if I have provided any false information in this Statement, or in the documents submitted in support of

this Statement, that I may be charged with and convicted of a Class A misdemeanor.

I also understand that if I have provided false information in this Statement, or in the documents submitted in support of

this Statement, the District may file a civil action against me to recover the costs of school attendance for the student.

_________________________________________________________ _______________________

Signature of Parent/Guardian Date