OTHS Check List for Freshman/New Student to the DISTRICT

Freshman must:

• Call the Main Office at 618-632-3507 to

schedule an appointment to turn in the following

or email to SchulteK@oths.us

• Provide copies of Proofs of Residency (see

below for required documents)

• Complete required registration forms

• Provide copy of state issued birth certificate

• Provide proof of 8th grade graduation (if not

coming from a feeder school)

New Student Must:

• Call main office at 618-632-3507 to schedule an

appointment to turn in the following or email to

SchulteK@oths.us

• Prove copies of Proofs of Residency (see below

for required documents)

• Complete required registration forms

• Provide copy of state issued birth certificate

• Copy of Unofficial Transcript

• Provide Student Transfer form (if coming from

an Illinois High School)

You will receive a call from the Guidance Office

after all forms to set up the student’s schedule.

New Student with Special Needs Must Also:

• Provide a copy of the students IEP/504 prior to

the scheduled appointment, and meet with

Director of Special Education Services to

develop a schedule.

Proofs of Residency

COLUMN A COLUMN B

Current

Lease/Mortgage

Utility Bill (water, gas,

phone)

Home/Rental

Insurance

Voters Registration Cards Are

Not Accepted

Property Tax

Bill/Receipt

* Falsifying residency information for the purpose of a child attending school in a district is a Class C misdemeanor. Scheduled students found to be living outside of the district will be

dropped.

Student’s Name (Please Print)

______________________________________________

Grade________

Feeder School Freshman/ New Student

Checklist

✓ Parent Use: Office Use:

☐ Copies of Proof of Residency

☐ Birth Certificate

☐ Registration Form

☐ Home Language Survey

☐ Race Ethnicity

☐ Every Student Succeeds Act Data

☐ Medical Forms (due within the 1st 30 days)

☐ Student Records Release Form

☐ Remote Learning Survey

Additional forms required for New Student:

☐ Proof of Completion of 8th grade (Freshman

only)

☐ Transcript (10th - 12th grade students)

☐ Principal's Concurrence Form (10th - 12th

students)

☐ Illinois Student Transfer Form

Additional Forms for New Student w/ Special Needs

☐ IEP

☐ 504

The parent’s signature affixed to this document

indicates that the parent has access to, and has or

will read the O’Fallon Township High School

Student Handbook which is located on the OTHS

website at www.oths.us or will request a hard copy

through an OTHS Main Office.

Parent

Signature__________________________________

Date___________________________

COVID-19 Daily Self-Certification

Instructions:

In accordance with the Illinois Department of Public Health and Illinois State Board of Education requirements, students must be screened each day for COVID-19 symptoms and other criteria prior to entering a school building.

Parents must screen their child each day prior to sending their child to school.

If your child does not meet all the following criteria, you must keep your child at home and notify the school of your child’s absence.

By sending your child to school, you are certifying you have screened your child and he/she meets all the following criteria to attend school.

D

Criteria to Attend School – Checked Daily

My child does not have a temperature over 100.4F.

My child is not taking fever-reducing medicines, such as those that contain aspirin, ibuprofen or acetaminophen, in order to reduce his/her fever.

My child has not had close contact or cared for someone with COVID-19 within the past 14 days.

My child has not returned from travel outside the United States or on a cruise ship or river boat within the past 14 days.

My child has not been directed to self-quarantine by a health care provider.

My child has not been directed to self-quarantine by the County or State Department of Public Health.

My child does not have any of the following symptoms:

Chills

Cough

Shortness of breath or difficulty breathing

Fatigue

Muscle or body aches

Headache

New loss of taste or smell

Sore Throat

Congestion or runny nose

Nausea or vomiting

Diarrhea

Student Health Screen

COVID-19 Visitor Checklist

Visitor Name: ___________________________

Date: ______________ Time: ______________ Phone Number: _______________________

Building Visited (Circle One): OTHS Smiley OTHS Milburn Transition House

Checklist

Question Yes No

Do you have a temperature over 100.4F? ☐ ☐

Are you taking fever-reducing medicines, such as those that contain aspirin, ibuprofen or acetaminophen, in order to reduce your fever? ☐ ☐

Have you had close contact or cared for someone with COVID-19 within the past 14 days? ☐ ☐

Have you returned from travel outside the United States or on cruise ship or river boat within the past 14 days? ☐ ☐

Are you experiencing any of the following symptoms?

Chills ☐ ☐

Cough ☐ ☐

Shortness of breath or difficulty breathing ☐ ☐

Fatigue ☐ ☐

Muscle or body aches ☐ ☐

Headache ☐ ☐

New loss of taste or smell ☐ ☐

Sore Throat ☐ ☐

Congestion or runny nose ☐ ☐

Nausea or vomiting ☐ ☐

Diarrhea ☐ ☐ D

If the visitor replied YES to any of the questions above, do not permit the visitor to enter school property.

Upon entry to school property instruct the visitor to:

o Wash their hands or use alcohol-based hand sanitizer.

o Wear a cloth face covering at all times.

o Observe social distancing by avoiding close contact with other individuals.

Every visitor must be screened according to this checklist prior to

entering school property.

O’Fallon Township High School District #203 Registration Form Student Information – Student’s name must appear exactly as it is shown on the birth certificate LAST NAME FIRST NAME MIDDLE NAME

GENDER BIRTH DATE (MM/DD/YYYY) BIRTH CITY BIRTH STATE BIRTH COUNTRY*

*If the student was born in a country other than the USA, please list the approximate date that your student entered a school in the USA for the first time:

Is this student currently in foster care? Yes No Parent / Guardian(s) First Family (with whom the student lives) Information – Please list the preferred contact first. FIRST NAME LAST NAME RELATIONSHIP TO THE STUDENT CELL PHONE

E-MAIL ADDRESS MARITAL STATUS WORK PHONE

FIRST NAME LAST NAME RELATIONSHIP TO THE STUDENT CELL PHONE

E-MAIL ADDRESS MARITAL STATUS WORK PHONE

Home Address of Student and first family (with whom the student lives) STREET ADDRESS, BOX#, LOT#, RR# CITY, STATE, ZIP CODE PRIMARY PHONE

Is there another guardian/second family who should receive district information such as grades, email notifications, etc.? Yes No FIRST NAME LAST NAME RELATIONSHIP TO THE STUDENT CELL PHONE

E-MAIL ADDRESS MARITAL STATUS WORK PHONE

FIRST NAME LAST NAME RELATIONSHIP TO THE STUDENT CELL PHONE

E-MAIL ADDRESS MARITAL STATUS WORK PHONE

Are there any siblings attending OTHS at either campus? Yes No (If yes, please list siblings)

EMERGENCY CONTACT INFORMATION – Please list 2 responsible adults who may assume responsibility for your student if you cannot be reached. NAME 1 RELATIONSHIP TO STUDENT PHONE NUMBER

NAME 2 RELATIONSHIP TO STUDENT PHONE NUMBER

Previous school or feeder school attended: NAME OF SCHOOL

Address of previous school: STREET CITY, STATE, ZIP CODE

Additional high school attended: NAME OF SCHOOL

Address of previous high school: STREET CITY, STATE, ZIP CODE

Has your student ever been enrolled in the following programs? Does this student have an active IEP?

SPECIAL EDUCATION 504 PLAN FREE/REDUCED LUNCH Yes No I verify that the above information is correct. OFFICE USE ONLY: DATE______________

GRADE ______STUDENT ID____________ SIGNATURE OF PARENT OR GUARDIAN DATE

LOCKER #__________ RE-ENTER Y or N

EVERY STUDENT SUCCEEDS ACT

Data Collection Requirement

New Federal Requirement: Every Student Succeeds Act (ESSA), requires schools to collect military

student identifier information. To be completed by the student’s parent or guardian.

Students Name:

Last Name First Name MI Date of Birth

1. Is the student a dependent of a member of the United States military service in the Active Duty

Army, Navy, Air Force, Marine Corps, or Coast Guard?

☐Yes (please complete this section) ☐NO - Skip to question 2.

Name of Parent/Guardian:

Rank

Branch of Service ☐ ARMY ☐ AIR FORCE ☐ NAVY ☐MARINES ☐COAST GUARD ☐NATIONAL GUARD (Full-Time)

WITHIN ILLINOIS Organization Name Location Phone Number:

OUTSIDE ILLINOIS Organization Name Location Phone Number

2. Is the student a dependent of someone working on Federal Property within the state of Illinois?

☐Yes ☐NO – Skip to Question 3.

Name of Parent/Guardian:

Employer: Address of Employer

Phone:

3. Is the student a dependent of someone working on Federal Property outside the state of Illinois?

☐Yes ☐NO – Skip to question 4.

Name of Parent/Guardian:

Employer:

Address of Employer:

Phone:

4. None of the above ☐

5. I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT:

____________________________________________________________________________________________________________________

Parent or Guardian Signature Date

Home Language Survey

The state requires the district to collect a Home Language Survey for every new student. This

information is used to count the students whose families speak a language other than English at

home. It also helps to identify the students that need to be assessed for English language

proficiency.

If the answer to either of the following questions is yes, the law requires the school to assess

your student’s English language proficiency. The test involves a lengthy exam taken outside

of the class. It may result in enrollment in English as a Second Language (ESL) which is

provided off campus and limits the course selection.

Please answer the questions below and return this survey to the OTHS guidance office.

Student’s Name:____________________________________________

1. Does anyone primarily speak a native language other than English in your home?

Yes What language? ___________________________

No

2. Does your student primarily speak a native language other than English in your

home?

Yes What language? ___________________________

No

If the answer to either question is YES, the law requires the school to assess your

student’s English language proficiency, and consider the need for English as a Second

Language services for your child.

____________________________________ _______________________

Parent or Guardian Signature Date

O’FALLON TOWNSHIP HIGH SCHOOL

DISTRICT NO. 203

EXCELLENCE IN EDUCATION FOR EVERY STUDENT EVERY DAY

Smiley Campus

600 South Smiley St.

O’Fallon, IL 62269

Dr. Darcy G. Benway

Superintendent

Smiley Campus

(618) 632-3507

(618) 206-2468 Fax

Milburn Campus

650 Milburn School Rd.

O’Fallon, IL 62269

Rich Bickel

Principal

Milburn Campus

(618) 622-9647

(618) 622-9630 Fax

The mission of O’Fallon Township High School is to access the talents of community, family and staff to provide a positive environment that maximizes the potential of students to become informed decision makers, engaged learners, and responsible citizens in an ever-changing and diverse society.

www.oths.k12.il.us

Illinois State Board of Education

New U.S. Department of Education Race and Ethnicity Data Standards

Student’s Name: _________________________________________________________________

Part A. Is this student Hispanic/Latino? (A person of Cuban, Mexican, Puerto Rican, South or

Central American, or other Spanish culture or origin, regardless of race.) Choose only one

No, not Hispanic/Latino

Yes, Hispanic/Latino

The question above is about ethnicity, not race. No matter which answer you selected, continue and respond to

the question below by marking one or more boxes to indicate what you consider this student’s race to be.

Part B. What is the student’s race? Choose one or more

American Indian or Alaska Native (A person having origins in any of the original peoples

of North and South America, including Central America, and who maintains tribal affiliation or

community attachment.)

Asian (A person having origins in any of the original peoples of the Far East, Southeast

Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea,

Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.)

Black or African American (A person having origins in any of the black racial groups of

Africa.)

Native Hawaiian or Other Pacific Islander (A person having origins in any of the original

peoples of Hawaii, Guam, Samoa, or other Pacific Islands.)

White (A person having origins in any of the original peoples of Europe, the Middle East,

or North Africa.)

Note: Data collection on this form must be maintained by the school district for three years. However, when there is

litigation, a claim, an audit, or another action involving this record, the original responses must be retained until the

completion of the action.

Parent Signature_______________________________________________Date________________

INSTRUCTIONS: This form is to be filled out by the student’s parents or guardians, and both questions must

be answered. Part A asks about the student’s ethnicity and Part B asks about the student’s race. If you

decline to respond to either question, the school district is required to provide the missing information by

observer identification.

STUDENT RECORDS RELEASE FORM

Student records are released to colleges, universities, military academies and branches, and recruiters, including

athletic recruiters, for the purposes of college applications, athletic recruitment, military recruitment, or dual credit.

Per the Illinois School Student Records Act, parent consent (if the student is under 18) or student consent is necessary

to release said documents.

The methods or forums for release of student records may include any of the below.

Docufide Sender, via Parchment, is a platform O’Fallon Township High School utilizes to deliver electronic

transcripts to colleges, scholarship organization, the military, NCAA Clearinghouse, and other organizations of the

Student’s choice. To utilize Parchment, a student will create an account with Parchment and select the colleges,

scholarship organizations, military, NCAA Clearinghouse, and other organizations for which he/she chooses. The

student controls his/her account. OTHS is not responsible for the student’s account including the content or selections

the student makes through the account. Parent/guardian/student 18 years or older, is providing consent for Docufide

Sender, via Parchment, and for OTHS to deliver my Student’s eTranscripts to the colleges, scholarship organization,

the military, NCAA Clearinghouse, and other organizations my Student and/or I select through the Parchment

Program.

Common Application, also known as Common App, is an online application platform that students us to apply to

participating colleges and universities. Please see https://www.commonapp.org/ for a complete list of participating

colleges and universities as well as terms and conditions contained in the Terms of Use.

Coalition for College, also known as Coalition App, is an online application platform that students use to apply to

participating colleges and universities. Please see http://www.coaltionforcollegeaccess.org/ for a complete list of

participating colleges and universities as well as terms and conditions contained in the Terms of Use.

Common Black College Application (CBCA), is an online application platform that students use to apply to

participating historically black colleges and universities (HBCU). Please see https://commonblackcollegeapp.com/

for a complete list of participating colleges and universities as well as terms and conditions.

United States Service Academies including United States Military Academy, United States Naval Academy, United

States Coast Guard Academy, United States Merchant Marine Academy, United States Air Force Academy.

Southwestern Illinois College: Students enrolled in a dual credit class with SWIC must meet qualifying criteria to

be eligible to earn dual credit. To verify the students meet the qualifying criteria, an unofficial copy of the student’s

transcript is provided to the SWIC Dual Credit Department.

NCAA Clearinghouse: Students intending to play a competitive sport at a college or university are required to submit

information to the NCAA Clearinghouse. Student records information may be shared with coaches and athletic

recruiters.

The purpose for this disclosure is for use in a Student’s post-secondary educational/athletic programming and

applications. The consent to release records is voluntary. I understand that if I do not grant consent, the above

records will not be released to the above recipients and I will not hold OTHS responsible for resulting consequences

with regard to college applications, admissions, or scholarships.

____________________________________________________ ________________

Signature Parent/Guardian/Student (if student is 18 years of age) Date

Photographs/Video Recordings: Photographs or video recordings of students may be taken during their OTHS

experience for directory type information, as part of extracurricular participation, during video lessons for home

learners or to meet student teacher licensure requirements, etc. I understand that I can revoke consent for such images

of my student to be used by contacting the main office.

____________________________________________________ ________________

Signature Parent/Guardian/Student (if student is 18 years of age) Date

Fee Description Amount

Registration/Books/Technology $175

Athletic Participation $150/sport

Marching Band/Show Choir Participation

$150/activity

Extracurricular Participation Maximum

$300/student

Driver Education $250

Student Parking - Full Year Permit

$50/year

Student Parking - One Semester Permit

$35 per semester

OTHS Student Fees

Fees can be paid at school or online through Family Access. Students will not be allowed to purchase parking permits or receive graduation tickets. Fees are not prorated and are not rebated under any circumstances. All purchases for parking permits are final.

Smiley and Milburn campuses will be open the following dates and times

Aug. 3rd 7:30 – 3:00

Aug. 4th & 5th 11:30 – 7:00

Aug. 6th & 7th 7:30 – 3:00

During these times students may

Tour the Buildings

Take ID Pictures (Security booth)

Pay Fees (Superintendents office at Smiley/ Main office at Milburn)

Purchase Parking Passes (Students must have a zero balance to purchase a pass in the

attendance office)

Check out Electronic Devices

*Face masks will be required to enter the buildings and must be worn at all times

*Bathrooms and water fountains will not be available