Point Isabel Independent School District Enrollment Checklist

*New Students:(Never enrolled in a Texas Public School)

REQUIRED DISTRICT FORMS (Yearly): Check: √ 1. Enrollment Form2. Volunteer Form3. Emergency/Health Card4. Student Release Card5. Residency Questionnaire7. Migrant Survey8. Health Services Form9. Tuberculosis Questionnaire10. Access to District’s Technology Resources Form11. Personal Use of Electronic Devices for Instructional Purposes12. Notice Regarding Directory Information13. Bus Transportation Form14. Ethnicity Questionnaire15. Home Language Survey - Only (check one) for each response16. Income Survey17. Optional Flexible School Year18. Random Drug Testing Program (secondary students)19. Parent, Student and School Compact

*Required Documentation:• Copy of DL of the person enrolling the child.• Proof of residence in the parent or guardian's name

• Copy of bill (light, water, cable)• Receipt for utility deposit• Deed• Unexpired lease• District tax statement• Homestead exemption

• For PK: Income verification paperwork (income taxes, check stub, etc.)

“PIISD does not discriminate on basis of race, color, national origin, sex, religion, age or disability in employment or provision of services, programs or activities”

Revised: May 2017

20. Acknowledgment Form - Receipt of Student Code of Conduct and Handbook 21. Military and Foster Care Form

“PI-ISD does not discriminate on basis of race, color, national origin, sex, religion, age or disability in employment or provision of services, programs or activities.” “PI-ISD no discrimina a base de raza, color, origen nacional, religión, sexo, edad o discapacidad en empleo en la provisión de servicios o actividades.”

REVISED 5-2-2011

POINT ISABEL INDEPENDENT SCHOOL DISTRICT

Enrollment Form

_________________________________________________________________________________________ Student’s Last Name (apellido) First Name (primer nombre) Middle Name (segundo nombre)

__________________________________________________________________________________________ Date of Birth (fecha de nacimiento) Place of birth (lugar de nacimiento) Social Security# (numero social)

__________________________________________________________________________________________

Physical Address (domicilio físico) Mailing Address (domicilio de correspondencia) City, State, Zip Code (ciudad, estado)

__________________________________________________________________________________________ Home Telephone (teléfono de Domicilio) Work Telephone (teléfono de trabajo) Cell Phone (teléfono celular)

__________________________________________________________________________________________ Previous School Attended (escuela previamente asistido) City, State (ciudad, Estado) Grade Level (grado/nivel)

__________________________________________________________________________________________ Mother’s/Guardian’s Name (nombre de madre) Occupation (ocupación) Work & Cell Phone (teléfono de trabajo y celular)

__________________________________________________________________________________________ Father’s/ Guardian’s Name (nombre de padre) Occupation (ocupación) Work & Cell Phone (teléfono de trabajo y celular)

__________________________________________________________________________________________ Father’s/ Guardian’s Email Address (correo electronic de padre) Mother’s/Guardian’s Email Address (correo electronic de madre)

With Whom Does The Student Live? (¿Con quien vive el estudiante?) Both parents Father Mother Guardian

Ambos padres Padre Madre Guardián

Signature of Parent or Guardian /Firma de Padre o Tutor Date/Fecha

IN CASE OF AN EMERGENCY, YOU MAY CONTACT: (En caso de emergencia, llama a)

_______________________________________________________________________________________ Name (nombre) Relationship (relación) Physical address (domicilio físico) Telephone (# teléfono)

Brothers/Sisters (Hermanos)

__________________________________________________________________________________________ Name (nombre) School Attending (escuela que asisten) Grade (grado)

____________________________________________________________________________________________________________

Name (nombre) School Attending (escuela que asisten) Grade (grado)

____________________________________________________________________________________________________________

Name (nombre) School Attending (escuela que asisten) Grade (grado)

“PIISD does not discriminate on basis of race, color, national origin, sex, religion, age or disability in employment or provision or services, programs or activities” “PIISD no discrimina en base de raza, color, nacionalidad origen, sexo, religión, edad o incapacidad en empleo o provisión de servicios, programas o actividades”

Point Isabel Independent School District 101 Port Road

Port Isabel, Texas 78578 http://www.pi-isd.net

Dear Parents,

The Point Isabel ISD invites you to become a campus or district volunteer. Please indicate your choices below: ____ Yes, I want to volunteer for the committee indicated below. If yes, please select a committee below. ____ No, I am not able to volunteer at this time.

(SBDM)-Site-Based Decision Making: The purpose of this committee is to involve all stakeholders, including parents, in thejoint development of the campus plans and the process of school review and improvement. Included in these plans is the goalof implementing effective parent involvement activities to promote student achievement.

(CATCH)-Coordinated Approach to Child Health: This committee works together as a campus team select and promote avariety of activities that will teach students to live a healthier lifestyle. The campus committee meets once a month.

(SHAC)-School Health Advisory Council: This is a District committee that meets four times a school year and workscollaboratively to advise and support the District’s efforts to assess their needs and to design programs to help children developthe knowledge, skills, and attitudes they need to become healthy, productive citizens.

(DEIC)-Districtwide Educational Improvement Council: The purpose of this District committee is to involve all stakeholders,including parents, in the joint development of the District plan and the process of District review and improvement. Includedin these plans is the goal of implementing effective parent involvement activities to promote student achievement.

Estimados padres de familia,

Point Isabel ISD les invita a ser voluntario en un comité. Por favor indique sus preferencias marcando abajo:

_____ Sí deseo ser voluntario (a) en el comité indicado abajo. Por favor de indicar el comité abajo: _____ No podre ser voluntario(a) en este momento.

(SBDM)-Site-Based Decision Making: La meta de este comité es para incluir a todos los participantes incluyendo los padresde familia en el procedimiento de formar y revisar los programas escolares incluyendo un plan de actividades para promover alos padres a participar en el desarrollo de los estudiantes.

(CATCH)-Coordinated Approach to Child Health: La meta de este comité es para promoví los estudiantes a vivir una vida mássaludable. El comité se reunía una vez por mes.

(SHAC)-School Health Advisory Council: Éste comité del distrito se reunía cuatro veces por año y la meta es para trabajarjuntos para avisar programas al distrito para ayudar a los estudiantes a vivir una vida productiva y saludable.

(DEIC)-Districtwide Educational Improvement Council: La meta de este comité del Distrito es para incluir a todos losparticipantes incluyendo los padres de familia en el procedimiento de formar y revisar las programas del Distrito incluyendoun plan de actividades para promover a los padres a participar en el desarrollo de los estudiantes.

_____________________ _______________________ ________________ Parent/Guardian Name Parent/Guardian Signature Date Nombre del padre o tutor Firma del padre o tutor Fecha

_____________________ _______________________ _________________ Home Phone Number email address Cell Phone Number Teléfono de casa correo electrónico Teléfono celular

Please sign and return to your child’s teacher. Favor de firmar y regresar a la escuela con su hijo/a.

2017-2018 Point Isabel Independent School District Emergency Health Card/Tarjeta de Emergencia Child hija/o

Last Name/apellido: First & Middle Name/nombre: Date of Birth/fecha de nacimiento: Grade/grado: Teacher/Maestra/o:

Address-Home/ Mailing address/ Home Telephone/ direccion de casa: direccion de correo: telefono de casa: Health Problems or Conditions/ Medications/ enfermedades cronicas o condiciones: medicamentos:

Allergies/ Family Doctor Name, phone and city/ alergias: Doctor Familiar, nombre ,telefono y ciudad:

Mother/Madre/Guardian/Tutor: Home Telephone/telefono de Casa: Work Telephone/telefono de trabajo: Cellular:

Father/Padre/Guardian/Tutor: Home Telephone/telefono de Casa: Work Telephone/telefono de trabajo: Cellular:

List 3 people (18 years or older)who may assume care of your child if you are unavailable/De nombres de 3 personas (18 anos o mayor) que puedan hacerse cargo del estudiante en caso de que los padres o tutores no se encuentren en una emergencia: Name/nombre Telephone/telefono (home/casa, work/trabajo/cell) Relationship/relacion 1) 2) 3) I, the undersigned, do hereby authorize the nurses of the Point Isabel Independent School District to do the following: Contact directly the persons named on this card; Contact directly the physician/health provider named on this card for pertinent health information on my child; Notify the teacher/administrator or health provider of my child’s health condition. If the parent/designee is unavailable, the school officials may take whatever action is deemed necessary, in their judgement, for the health of my child. I will not hold the school district financially responsible for the emergency care and/or treatment of my child. Yo el suscrito autorizo a las enfermeras del Districto Escolar Independiente de Point Isabel hacer lo siguiente: Communicarse directamente con las personas nombradas en esta tarjeta; Communicarse directamente con el medico/proveedor de salud nombrado en esta tarjeta para obtener informacion medica pertinente a la salud de mi hijo/hija;.Notificar el maestro/administrator o proveedor de salud acerca del estado de salud de mi hijo/hija. En caso que los padres/personas designadas sean inaccesibles, los oficiales de la escuela pueden tomar cualquier accion que sea necesaria,segun su juicio para el bienestar de mi hijo/hija. No hare finacieramente responsable al Districto Escolar por el tratamiento de emergencia o cualquier tratamiento que reciba mi hijo/hija.

Signature of Parent or Guardian /Firma del Padre o Tutor Date/Fecha “PIISD does not discriminate on basis of race, color, national origin, sex, religion, age or disability in employment or provision of services, programs or activities.”

“PIISD no discrimina a base de raza, color, origen nacional, religión, sexo, edad o discapacidad en empleo en la provisión de servicios o actividades."

Teacher: Revised 6-14-2012 POINT ISABEL INDEPENDENT SCHOOL DISTRICT

Student Release Card ENROLLMENT DATE: LOCAL ID # GRADE LEVEL: DATE OF BIRTH /Fecha de nacimiento: **************************************************************************************************************************************

STUDENT NAME Nombre de estudiante PHYSICAL ADDRESS Dirección a domicilio MAILING ADDRESS Dirección de correo

MOTHER’S NAME Nombre de madre

MOTHER’S HOME PHONE Teléfono de casa

MOTHER’S WORK PHONE teléfono de trabajo

MOTHER’S CELL PHONE celular

FATHER’S NAME Nombre de Padre

FATHER’S HOME PHONE Teléfono de casa

FATHER’S WORK PHONE Teléfono de trabajo

FATHER’S CELL PHONE Celular

PERSONS THAT HAVE PERMISSION TO PICK UP YOUR CHILD: (Must be over 18 and have a valid ID with photo) Personas que tienen permiso para recoger su niño(a): (Solamente personas mayores de 18 años y con credencial con fotografía)

NAME Nombre HOME/WORK/CELL PHONE teléfonos RELATIONSHIP relación

NAME Nombre HOME/WORK/CELL PHONE teléfonos RELATIONSHIP relación

NAME Nombre HOME/WORK/CELL PHONE teléfonos RELATIONSHIP relación

SIGNATURE OF PARENT/GUARDIAN (FIRMA DEL PADRE) DATE fecha

“PI-ISD does not discriminate on basis of race, color, national origin, sex, religion, age or disability in employment or provision of services, programs or activities.” “PI-ISD no discrimina a base de raza, color, origen nacional, religión, sexo, edad o discapacidad en empleo en la provisión de servicios o actividades.”

Revised by THEO on April 27, 2009

Student Residency Questionnaire 

The information on this form is required to meet the law known as the McKinney-Vento Act 42 U.S.C. 11434a(2), which is also known as Title X, Part C, of the No Child Left Behind Act. The answers you give will help the school determine the services the student may be eligible to receive.

Presenting a false record or falsifying records is an offense under Section 37.10, Penal code, and enrollment of the child under false documents subjects the person to liability for tuition or other costs. TEC Sec. 25.002(3)(d).

Name of Student: Gender: Male Female Last First Middle

Birth Date: / / Grade: Student Id #: Month / Day / Year

Check the box that best describes with whom the student resides. (Please note: legal guardianship may be granted only by a court; students living on their own or with friends or relatives who do not have legal guardianship are allowed to enroll in and attend school. The school cannot require proof of guardianship for enrollment or continued attendance.)

❏ Parent(s)❏ Legal Guardians(s)❏ Caregiver(s) who are not legal guardian(s) (Examples: friends, relatives, parents of friends, etc.)❏ Other

Name of person with whom student resides:

Address:

City: ZIP:

Home Phone #: Cell Phone #: Other Emergency #:

Length of Time at Present Address:

Length of Time at Previous Address:

Name of the school where student is enrolled or in which student is attempting to enroll:

Last District Attended: Last School Attended:

Please check only one box that best describes where the student is presently living:

❏ In my own home or apartment, in Section 8 housing, or in military housing with parent(s), legal guardian(s), orcaregiver(s) (if you checked this box, check one or both of the boxes below, if applicable:) (CODE=N)

❏ My home has no electricity (CODE=U)❏ My home has no running water (CODE=U)

❏ In the home of a friend or relative because I lost my housing (examples: fire, flood, lost job, divorce, domesticviolence, kicked out by parents, parent in military and was deployed, parent(s) in jail, etc.) (CODE=D)

❏ In a shelter because I do not have permanent housing (examples: living in a family shelter, domestic violenceshelter, children/youth shelter, FEMA housing) (CODE=S)

Revised by THEO on April 27, 2009

❏ In transitional housing (housing that is available for a specific length of time only and is partly or completely paidfor by a church, a nonprofit organization, or another organization) (CODE=S)

❏ In a hotel or motel (examples: because of economic hardship, eviction, cannot get deposits for permanent home,flood, fire, hurricane, etc.) (CODE=HM)

❏ In a tent, car, van, abandoned building, on the streets, at a campground, in the park, or other unsheltered location(CODE=U)

❏ None of the above describe my present living situation Briefly describe your situation: ________________________________________________________________________________________________________________

Factors contributing to the student’s current living situation (check all that apply):

❏ Natural disaster❏ Tornado, storm, flood, etc.❏ Hurricane, name: ________________________❏ Fire: prairie, forest, grass, lightning strike, etc.

❏ Family issues such as divorce, domestic violence, kicked out by parents, student left due to family conflict, etc.❏ Home issues such as lack of electricity, water, heat, adequate home repair due to lack of funds, overcrowding,

mold, etc.❏ Military: Parent/guardian deployed, injured or killed in action❏ Incarceration of parent/guardian❏ Incapacitation of parent or guardian due to health, mental health, drugs/alcohol, or other factors❏ Home fire not due to natural causes (i.e., faulty equipment/appliances/wiring, furnace, stove, fireplace, etc.)❏ Economic hardship:

❏ Loss of job resulting in inability to pay rent or mortgage❏ Income from part-time or low paying job does not cover cost of housing in the area❏ Loss of mortgage, including loss of mortgage of landlord if student/student’s family is renting❏ Eviction record and/or inability to produce deposits for rent or utilities

❏ High medical bills that leave little or no money for housing❏ Lack of affordable housing in the area❏ Minor student unable to afford housing on my own❏ None of the above describe the main reasons for my present living situation Briefly explain the contributing

factors: ________________________________________________________________________________________________________________________________________________________________________________

Please provide the following information for school-age siblings (brothers and/or sisters) of the student:

Name Grade Level School District

Signature of Parent/Legal Guardian/Caregiver/Unaccompanied Student Date

For School Use Only I certify the above named student qualifies for the Child Nutrition Program under the provisions of the McKinney-Vento Act.

McKinney-Vento Liaison Signature Date

2. Have you moved within the last 3 years to find this type of work?Yes _____ No _____

3. Is this type of work an important source of income for your family?Yes _____ No _____

If you answered “yes” to some or all of the questions above, and educational representative may contact you to find out whether your child is eligible for additional educational services. Please provide the following information:

Where did you migrate to?__________________________________________________

Parent/Guardian Name:____________________________________________________________

Current physical address:____________________________________________________

Current mailing address:_____________________________________________________

Phone #s where you can be reached during the day: ______________________________

Please call the Migrant Department at 943-0663 if you have any questions

2017-2018 Point Isabel ISD Family Survey—Migrant Education Program

Student Name: Grade: Date: Campus:

Dear Parents, In order to better serve your children, the Point Isabel Independent School District would like to identify students who may qualify to receive additional educational services.

The information you provide below will be kept confidential. Please answer the following questions and return this form to your child’s school.

Or, if you prefer, for more information, call: ___________________________________________

1. Did you seek or obtain employment in agricultural or fishing related activities within the last three years? (e.g., fieldwork, canneries, lumbering, dairy work, meat processing) If yes, check all that apply below.

Fruit, vegetables, soybeans, sunflower, cotton, wheat, grain,

sugar beets, agricultural farms or ranches, fields and vineyards

Working in a cannery Working in a dairy farm

Working in a fishery Working in a slaughter-house Working in a poultry farm

Working in a plant nursery, orchard, tree-growing, or harvesting.

Other similar work, please describe:

Point Isabel Independent School District Health Services Form

REQUEST FOR FOOD ALLERGY INFORMATION /SOLICITUD DE INFORMACIÓN DE ALERGIA ALIMENTARIA

Student/ Estudiante: _____________________________________________________________________

Date of birth/ Fecha de Nacimiento: ______________________Grade/ Grado: _______________________

This form allows you to disclose whether your child has a food allergy or severe food allergy that you believe should be disclosed to the District in order to enable the District to take necessary precautions for your child’s safety.

“Severe food allergy” means a dangerous or life-threatening reaction of the human body to a food-borne aller-gen introduced by inhalation, ingestion, or skin contact that requires immediate medical attention.

Please list any foods to which your child is allergic or severely allergic, as well as the nature of your child’s al-lergic reaction to the food.

Esta forma permite que usted informe al distrito escolar si su hijo(a) tiene alergia a un alimento o alergia ali-mentaria severa. Esta información es importante para que el distrito tome las precauciones necesarias por el bienestar de su hijo(a).

"Alergia alimentaria grave" significa una reacción peligrosa o potencialmente mortal del cuerpo humano a un alergénico producido por los alimentos transmitidos por la inhalación, ingestión o contacto con la piel que requiere atención médica inmediata.

Describa alimentos que su hijo(a) es alérgico severamente, así como la naturaleza de la reacción alérgica de su hijo(a) a la comida.

Food / Comida: Nature of allergic reaction to the food/ Naturaleza de la reacción alérgica a los alimentos

The District will maintain the confidentiality of the information provided above and may disclose the information to teachers, school counselors, school nurses, and other appropriate school personnel only within the limita-tions of the Family Educational Rights and Privacy Act and District policy.

El distrito mantendrá la confidencialidad de la información proporcionada y puede dar la información a maes-tros, consejeros de la escuela, enfermeras y otro personal de la escuela que necesite saber esta información dentro de los límites de la política de derechos educativos de la familia y la ley de privacidad del distrito.

Parent/Guardian (print name) Padre/Tutor Legal: ______________________________________

Work phone/Teléfono del trabajo: ______ Home phone/ Teléfono de casa: ________

Parent/Guardian Signature/Firma del padre o tutor legal: __________________________

Date/Fecha: _________________

Date form was received by the school: ________________

10/11 1 of 1

TB Questionnaire

Name of Child____________________________________________________________Date of Birth ________________

Organization administering questionnaire______________________________________ Date_______________________

Tuberculosis (TB) is a disease caused by TB germs and is usually transmitted by an adult person with active TB lung disease. It is spread to another person by coughing or sneezing TB germs into the air. These germs may be breathed in by the child.

Adults who have active TB disease usually have many of the following symptoms: cough for more than two weeks duration, loss of appetite, weight loss of ten or more pounds over a short period of time, fever, chills and night sweats.

A person can have TB germs in his or her body but not have active TB disease (this is called latent TB infection or LTBI).

Tuberculosis is preventable and treatable. TB skin testing (often called the PPD or Mantoux test) is used to see if your child has been infected with TB germs. No vaccine is recommended for use in the United States to prevent tuberculosis. The skin test is not a vaccination against TB.

We need your help to find out if your child has been exposed to tuberculosis.

Place a mark in the appropriate box: Yes No Don't Know

TB can cause fever of long duration, unexplained weight loss, a bad cough (lasting over two weeks), or coughing up blood. As far as you know:

has your child been around anyone with any of these symptoms or problems? or has your child had any of these symptoms or problems? or has your child been around anyone sick with TB?

Was your child born in Mexico or any other country in Latin America, the Caribbean, Africa, Eastern Europe or Asia? Has your child traveled in the past year to Mexico or any other country in Latin America, the Caribbean, Africa, Eastern Europe or Asia for longer than 3 weeks?

If so, specify which country/countries?______________________________________ To your knowledge, has your child spent time (longer than 3 weeks) with anyone who is/has been an intravenous (IV) drug user, HIV-infected, in jail or prison or recently came to the United States from another country?

Has your child been tested for TB? Yes___ (if yes, specify date ____/____) No___ Has your child ever had a positive TB skin test? Yes___ (if yes, specify date ____/____) No___

For school/healthcare provider use only *************************************************************************************************** PPD administered Yes___ No___ If yes, Date administered _____/_____/______ Date read ______/______/_______ Result of PPD test __________ mm response

Type of service provider (i.e. school, Health Steps, other clinics) _______________________________________________

PPD provider __________________________________________ ______________________________________ signature printed name

Provider phone number ___________________________________

City ________________________________________________ County ________________________________________

If positive, referral to healthcare provider Yes___ No___

If yes, name of provider _______________________________________________________________________________

EF12-11494 TB Questionnaire for Children (Rev. 08/04)

DISTRICT’S TECHNOLOGY RESOURCES

PARENT: Please mark an X next to your selection.

I have read the District’s technology resources policy, associated administrative guidelines, and this user agreement. In consideration for the privilege of my child using the District’s technology resources, including internet access, I hereby release the District, its operators, and any institutions with which they are affiliated from any and all claims and damages of any nature arising from my child’s use of, or inability to use, these resources, including, without limitation, the type of damage identified in the District’s policy and administrative guidelines.

I give permission for my child to access all of the District’s technology resources and certify that the information contained on this form is correct.

OR

I do not give permission for my child to access the District’s technology resource for internet usage. I understand that my child may still have an account login to use school computers for more traditional tasks, such as word processing, e-books for reading or web-based software directly related to instruction/assessments, but no internet usage will be allowed during the school day. I hereby release the District, its operators, and any institutions with which they are affiliated from any and all claims and damages of any nature arising from my child’s use of, or inability to use, these resources, including, without limitation, the type of damage identified in the District’s policy and administrative guidelines.

___________________________________________ ______________________________________

Print Name of Parent/Guardian Signature of Parent/Guardian

___________________________________ Date

STUDENT:

I understand that my use of the District’s technology resources is not private and that the District will monitor my activity.

I have read the District’s technology resources policy, associated administrative guidelines, and this user agreement and agree to abide by their provisions. I understand that violation of these provisions may result in suspension or revocation of access to the District’s technology resources.

___________________________________________ ______________________________________

School Grade

___________________________________________ ______________________________________

Print Name of Student Signature of Student

___________________________________ Date

Note: The student must return this form to the homeroom teacher immediately after signing it on the day provided.

“PIISD does not discriminate on basis of race, color, national origin, sex, religion, age or disability in employment

or provision of services, programs or activities.”

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PERSONAL USE OF ELECTRONIC DEVICES FOR INSTRUCTIONAL PURPOSES

STUDENT: I wish to use the following personal electronic devices for instructional purposes while on campus:

□ Laptop/Netbook □ e-Reader □ Mobile Tablet □ Other ______________

I understand that my use of the District’s technology resources is not private and that the District will

monitor my activity. Students shall not use a telecommunication device, including a cellular telephone,or other electronic device in violation of district and campus rules. I understand that my personal electronic device may be searched by “appropriate” District administrators in accordance with policy FNF (Legal).

I have read the applicable District policies, associated administrative guidelines and this user agreement regarding the District’s technology resources and use of student-owned electronic devices and agree to abide by their provisions. I understand that violation of these provisions may result in suspension or revocation of system access and/or suspension or revocation of permission to use my personal electronic device for instructional purposes while on campus.

___________________________________________ ______________________________________

School Grade ___________________________________________ ______________________________________

Print Name of Student Signature of Student

___________________________________ Date

PARENT: Please mark an x next to your selection.

I understand that my child’s use of the District’s technology resources, is not private and that the will District monitor his/her activity.

I have read the applicable District policies, associated administrative guidelines, and this user agreement regarding the District’s technology resources and use of student-owned electronic devices. I understand that the district will not offer technical support for my child’s personal electronic device. In consideration for the privilege of my child using their personal electronic device for instructional purposes, I hereby release the District, its operators, and any institutions with which they are affiliated from any and all claims and damages of any nature arising from my child’s use of, or inability to use, these resources, including, without limitation, the type of damage identified in the District’s policies and administrative guidelines.

I am aware that the District is not responsible for damage to or loss of my child’s personal devices brought from home. I am aware that the District will not provide technical support for my child’s personal electronic devices.

I give permission for my child to use his or her personal electronic device(s) at school for instructional purposes while on campus.

OR I do not give permission for my child to use his or her personal electronic device(s) at school for instructional purposes while on campus.

___________________________________________ ______________________________________

Print Name of Parent/Guardian Signature of Parent/Guardian

___________________________________ Date

The student must return this signed form in order to use personal electronic devices for instructional purposes.

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NOTICE REGARDING DIRECTORY INFORMATION AND PARENT’S RESPONSE REGARDING RELEASE OF STUDENT INFORMATION

State law requires the district to give you the following information: Certain information about district students is considered directory information and will be released to anyone who follows the procedures for requesting the information unless the parent or guardian objects to the release of the directory information about the student. If you do not want Point Isabel ISD to disclose directory information from your child’s education records without your prior written consent, you must notify the district in writing, within ten school days of your child’s first day of instruction for this school year.

This means that the district must give certain personal information (called “directory information”) about your child to any person who requests it, unless you have told the district in writing not to do so. In addition, you have the right to tell the district that it may, or may not use certain personal information about your child for specific school-sponsored purposes. The district is providing you this form so you can communicate your wishes about these issues.

For the following school-sponsored purposes—all District publications and announcements—directory information shall include student name; address; telephone listing; photograph; major field of study; degrees, honors, and awards received; grade level; most recent school previously attended; enrollment status; and participation in officially recognized activities and sports.

I object to the release of one or more of the following categories of my child’s directory information by Point Isabel ISD during the 2017-2018 school year for school-sponsored purposes:

_____ Name _____ Major Field of Study _____ Enrollment Status _____ Address Degrees _____ Grade Level _____ Telephone Listing _____ Honors and Awards Received _____ Activities & Sports _____ Photograph _____ Most Recent School Previously Attended

For all other purposes, directory information shall include student name; address; major field of study; degrees, honors, and awards received; grade level; most recent school previously attended; enrollment status; and participation in officially recognized activities and sports.

Please be advised that federal law requires districts receiving assistance under the Elementary and Secondary Education Act of 1965 to provide a military recruiter or an institution of higher education, on request, with the name, address, or telephone number of a secondary student unless the parent has advised the District that the parent does not want the student’s information disclosed without the parent’s prior written consent. If the parent or guardian objects to the release of directory information, please complete the following information and return to the campus principal.

I object to any release of my child’s directory information by Point Isabel ISD during the 2017 -2018 school year. I only object to the release of my secondary child’s directory information to a military recruiter or institution of higher education by Point Isabel ISD during the 2017-2018 school year.

____________________________________ _____________________________________

Print Name of Parent/Guardian Signature of Parent/Guardian

___________________________________ _____________________________________ Date Student ID

Student directory information will be released by Point Isabel ISD if no form is received.

“PIISD does not discriminate on basis of race, color, national origin, sex, religion, age or disability in employment

or provision of services, programs or activities.”

___________________________________________

Print Name of Student ___________________________________________

Campus

_____Display Student's Work

“PI-ISD does not discriminate on basis of race, color, national origin, sex, religion, age or disability in employment or provision of services, programs or activities.” “PI-ISD no discrimina a base de raza, color, origen nacional, religión, sexo, edad o discapacidad en empleo en la provisión de servicios o actividades.”

REVISED 5-2-2011

Campus: ______________________ Grade Level: ____________ Local ID # ___________________

POINT ISABEL INDEPENDENT SCHOOL DISTRICT

Bus Transportation Form

Please allow the student listed below to ride the bus to and from school:

Favor de permitir al estudiante de viajar en autobús de casa hacia la escuela:

_________________________________________________________________________________________ Student’s Last Name (apellido) First Name (primer nombre) Middle Name (segundo nombre)

__________________________________________________________________________________________

Physical Address (dirección a domicilio) City, State, Zip Code (ciudad, estado) Home Telephone (teléfono de Domicilio)

__________________________________________________________________________________________ Mother’s/Guardian’s Name (nombre de madre) Work & Cell Phone (teléfono de trabajo y celular)

__________________________________________________________________________________________ Father’s/ Guardian’s Name (nombre de padre) Work & Cell Phone (teléfono de trabajo y celular)

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

Signature of Parent or Guardian /Firma de Padre o Tutor Date/Fecha

***********************Students need approval from the Principal to ride another bus. Estudiantes

necesitan la aprobación del Director/a para viajar en otro autobús. ******************************

For School Use Only:

Uso Escolar:

Bus Number: ___________________________Bus Driver: _______________________________________

The United States Department of Education (USDE) requires allstate and local education institutions to collect data on ethnicityand race for students and staff. This information is used for stateand federal accountability reporting as well as for reporting tothe Office of Civil Rights (OCR) and the Equal EmploymentOpportunity Commission (EEOC).School district staff and parents or guardians of studentsenrolling in school are requested to provide this information. Ifyou decline to provide this information, please be aware that theUSDE requires school districts to use observer identification as alast resort for collecting the data for federal reporting.

Please answer both parts of the following questions onthe studentʼs or staff memberʼs ethnicity and race.

United States Federal Register (71 FR 44866)Part 1. Ethnicity:Is the person Hispanic/Latino? (Choose only one)�� Hispanic/Latino - A person of Cuban, Mexican, Puerto Rican, South or

Central American, or other Spanish culture or origin, regardless of race.�� Not Hispanic/LatinoPart 2. Race:What is the person’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 a 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 blackracial groups of Africa.

�� Native Hawaiian or Other Pacific Islander - A person having originsin 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, theMiddle East, or North Africa.

_______________________________________________________________________________________________________Student/Staff name (please print)

_______________________________________________________________________________________________________(Parent/Guardian)/(Staff) signature

_______________________________________________________________ ____________________________________Student/Staff Identification number Date

This space reserved for local school observer —upon completion and entering data in student software system,

file this form in student’s permanent folder.Ethnicity – choose only one: Race – choose one or more:�� Hispanic/Latino �� American Indian or Alaska Native�� Not Hispanic/Latino �� Asian

�� Black or African American�� Native Hawaiian or other Pacific Islander�� White

_______________________________________________________________________________________________________Observer signature

_______________________________________________________________ ____________________________________Campus DateTexas Education Agency – March 2010

Texas Education Agency/Agencia de Educación de TexasTexas Public School Student/Staff Ethnicity and Race Data Questionnaire

Cuestionario de Información de Datos Raciales y de Etnicidad de Estudiantes/Miembros de Personalde las Escuelas Públicas de Texas

El Departamento de Educación de Estados Unidos (USDE)requiere que todas las instituciones estatales y locales deeducación, recopilen datos sobre etnicidad y raza de los estudiantesy de miembros de personal. Esta información es utilizada para losreportes estatales y federales así como para reportar a la Oficina deDerechos Civiles (OCR) y a la Comisión de Igualdad en el Empleo(EEOC).Al personal del distrito escolar y los padres o representante legal deestudiantes que deseen matricularse en la escuela, se le requiereproporcionar esta información. Si usted rehúsa proporcionarla, esimportante que sepa que el USDE requiere que los distritosescolares usen la observación para identificación como últimorecurso para obtener estos datos utilizados para reportes federales.Favor de contestar ambas partes de las siguientes preguntas

sobre la etnicidad y raza del estudiante así como del miembro depersonal. Registro Federal de Estados Unidos (71 FR 44866).

Parte 1. Etnicidad:¿Es la persona Hispana/Latina? (Escoja solo una respuesta)�� Hispano/Latino – Una persona de origen cubano, mexicano, puertorriqueño,

centro o sudamericano o de otra cultura u origen español, sin importar la raza.�� No Hispano/LatinoParte 2. Raza:¿Cuál es la raza de la persona? (Escoja uno o más de uno)�� Indio Americano o Nativo de Alaska – Una persona con orígenes o de

personas originarias de Norte y Sudamérica (incluyendo America Central), y quemantiene lazos o apego comunitario con una afiliación de alguna tribu.

�� Asiático – Una persona con orígenes o de personas originarias del Lejano Este,Sureste de Asia o el subcontinente indio, incluyendo, por ejemplo a Cambodia,China, India, Japón, Corea, Malasia, Pakistán, las Islas Filipinas, Tailandia yVietnam.

�� Negro o Áfrico-Americano – Una persona con orígenes de cualquiergrupo racial negro de África.

�� Nativo de Hawai u otras islas del pacífico – Una persona con orígeneso de personas originarias de Hawai, Guam, Samoa u otras Islas del Pacífico.

�� Blanco – Una persona con orígenes de personas originarias de Europa, el MedioEste o el Norte de África.

_______________________________________________________________________________________________________Nombre del Estudiante/Miembro de Personal (por favor use letra de imprenta)

_______________________________________________________________________________________________________Firma (Padre/Representante legal)/(Miembro de personal)

_______________________________________________________________ ____________________________________Número de Identificación del Estudiante/ Fecha

Miembro del personal

This space reserved for local school observer —upon completion and entering data in student software system,

file this form in student’s permanent folder.Ethnicity – choose only one: Race – choose one or more:�� Hispanic/Latino �� American Indian or Alaska Native�� Not Hispanic/Latino �� Asian

�� Black or African American�� Native Hawaiian or other Pacific Islander�� White

_______________________________________________________________________________________________________Observer signature

_______________________________________________________________ ____________________________________Campus DateTexas Education Agency – March 2010

POINT ISABEL INDEPENDENT SCHOOL DISTRICT 101 Port Road Port Isabel, Texas 78578 (956)943-0000 Fax: (956)943-0014

HOME LANGUAGE SURVEY-19TAC Chapter 89, Subchapter BB §89.1215

TO BE COMPLETED BY PARENT OR GUARDIAN (OR STUDENT IF GRADES 9-12): The state of Texas requires that the following information be completed for each student that enrolls for the first time in Texas public schools. This survey shall be kept in each student’s permanent record folder.

NAME OF STUDENT STUDENT ID#

ADDRESS TELEPHONE #

CAMPUS

1. What language is spoken in your home most of the time? 2. What language does your child speak most of the time?

Signature of Parent/Guardian Date

Signature of Student if Grades 9-12 Date

----------------------------------------------------------------------------------------------------------------------------------

Cuestionario del idioma que se habla en el hogar

DEBE DE COMPLETARSE POR EL PADRE/MADRE/ O REPRESENTANTE LEGAL: (O POR EL ESTUDIANTE SI ESTA EN LOS GRADOS 9-12): El estado de Texas requiere que la siguiente información se complete para cada estudiante que se matricula por primera vez en una escuela pública de Texas. Este cuestionario se archivará en el expediente del estudiante.

NOMBRE DEL ESTUDIANTE #ID

DIRECCION TELEFONO

ESCUELA

1. ¿Qué idioma se habla en su hogar la mayoría del tiempo?

2. ¿Qué idioma habla su hijo/a la mayoría del tiempo?

Firma del Padre/Madre/ o Representante Legal Fecha

Firma del estudiante si está en los grados 9-12 Fecha

Date Received by District:_______________________

Point Isabel Independent School District

2017 – 2018 INCOME SURVEY

All documentation must be submitted prior to finalizing the registration process.

Student Name: I.D. # D.O.B.: Grade: Campus:

PART 1. ALL HOUSEHOLD MEMBERS Names of all household members (First, Middle Initial, Last)

Name of school or “NA” if child is not in school

Check if a foster child (legal responsibility of welfare agency or court) * If all children are foster children, skip to Part 5.

Check if NO

income

Part 2. BENEFITS: IF ANY MEMBER OF YOUR HOUSEHOLD RECEIVES [State SNAP], [FDPIR] OR [State TANF Cash Assistance], PROVIDE THE NAME AND CASE NUMBER FOR THE PERSON WHO RECEIVES BENEFITS AND SKIP TO PART 5. IF NO ONE RECEIVES THESE BENEFITS, SKIP TO PART 3. NAME:____________________________________________________________________ CASE NUMBER: __________________________________________________________ PART 3. IF ANY CHILD YOU ARE APPLYING FOR IS HOMELESS, MIGRANT, OR A RUNAWAY CHECK THE APPROPRIATE BOX HOMELESS MIGRANT RUNAWAY

PART 4. TOTAL HOUSEHOLD GROSS INCOME. You must tell us how much and how often. 1. NAME(List only household members with income)

2. GROSS INCOME AND HOW OFTEN IT WAS RECEIVEDEarnings From Work before deductions

Welfare, child support, alimony

Pensions, retirement, Social Security, SSI, VA benefits

All Other Income

(Example) Jane Smith $199.99/weekly $149.99/every other week $99.99/monthly $50.00/monthly

$______/___________________ $______/___________________ $______/___________________ $______/_____________

$______/___________________ $______/___________________ $______/___________________ $______/______________

$______/___________________ $______/___________________ $______/___________________ $______/______________

$______/___________________ $______/___________________ $______/___________________ $______/_____________

PART 5. SIGNATURE AND LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER (ADULT MUST SIGN) An adult household member must sign the application. If Part 4 is completed, the adult signing the form also must list the last four digits of his or her Social Security Number or mark the “I do not have a Social Security Number” box. I certify (promise) that all information on this application is true and that all income is reported. I understand that the school will get Federal funds based on the information I give. I understand that school officials may verify (check) the information. I understand that if I purposely give false information, my children may lose meal benefits, and I may be prosecuted.

Sign here: ___________________________________________________________________ Print name:_______________________________________________________________________

Address: ______________________________________________________________________ Home/Cell Phone: ___________________________________ Work Phone: ____________ Last four digits of Social Security Number: * * * - * * - ___ ___ ___ ___ I do not have a Social Security Number

DO NOT FILL OUT THIS PART. THIS IS FOR SCHOOL USE ONLY. Annual Income Conversion: Weekly x 52, Every 2 Weeks x 26, Twice A Month x 24 Monthly x 12

Total Income: ____________ Per: Week, Every 2 Weeks, Twice A Month, Month, Year Household size: ________ Categorical Eligibility: Free___ Reduced___ Denied___ Reason: _________________________Determining Official’s Signature: ______________Date: ________ Confirming Official’s Signature: _____________________________ Date: ___________ Verifying Official’s Signature: _______________________________Date: ________ “PI-ISD does not discriminate on basis of race, color, national origin, sex, religion, age or disability in employment or provisions of services, programs or activities.”

OPTIONAL FLEXIBLE YEAR PROGRAM

2017 – 2018 Point Isabel Independent School District Optional Flexible School Year Program

The Point Isabel Independent School District will be participating in the Optional Flexible School Year Program (OFSYP) for the 2017 – 2018 school year. By participating in the Optional Flexible School Year Program, students that meet all of the requirements set by the District will complete school with a minimum of 72,210 minutes of instruction (nine days) before the required 75,6000 minutes of instruction, which will be May 24, 2018. Students that do not meet the requirements will be required to attend the nine At–Risk Mandatory Instructional Days of school; making their final day of class June 8, 2018.

The mandatory requirements for students completing the school year on May 24, 2018, include the following:

Academic Promotion Requirements o Kindergarten requires mastery of reading and math skills as per the Kindergarten Promotion

Requirements. o Grades 1 – 8 require mastery of a 70 or better in reading, English and math and

an overall 70 average for all core subject areas as noted on the report card o Grades 9 – 12 requires students to obtain 5 credits and receive at least a 70 on all four core

subjects o Project SAIL secondary students require a 100% completion of Power Focus Area and 100% of

Projects submitted with a minimum of grade level performance on cognitive skills.

Assessment Requirements o Approaching Grade Level Performance on all State of Texas Assessments of Academic Readiness

(STAAR) for Reading and Math for grades 5 and 8 o Demonstrate personalized growth expectations measured by NWEA-MAP

Attendance Requirements Pre- Kindergarten – 12th grade students may only be absent 10 days during the Optional

Flexible Year Program (August 28, 2017 – May 24, 2018) Both excused and unexcused absences will count as an absence Opportunities to make up absences will not be permitted

IMPORTANT INFORMATION/CHANGES:

*Mandatory Attendance: Students who do not meet all of the above District requirements are required to

attend school for the nine additional days of instruction.

**Graduation Ceremonies: High School and Kindergarten participants will be determined as of the last

day of the Optional Flexible Year, May 24, 2018. Only those who meet the District requirements above will participate in the ceremonies.

***Summer School: Summer School (for promotion) will not be provided during the 2018 summer.

Intensive interventions will be provided during the nine At–Risk Mandatory Instructional Days of school. Students not meeting the requirements for promotion after June 8, 2018 will be retained.

____________________________________ _____________________________________

Print Name of Student Signature of Student _____________________________________ _____________________________________

Print Name of Parent/Guardian Signature of Parent/Guardian ___________________________________

Date “PIISD does not discriminate on basis of race, color, national origin, sex, religion, age or disability in employment or provision or services, programs or activities.”

Point Isabel Independent School District Parent and Student Agreement/Acknowledgement Form Participation in Student Random Drug Testing Program

Student’s Name: ______________________________________ ___________________________________ _____________ (last name) (first name) (middle initial)

Parent/Guardian Name: ____________________________________________________________________________________

Program Participation:

_____Athletics _____Band _____Cheerleading _____Academic UIL

_____Dance _____School Club _____Student Government

_____Student Driver _____Other (Please specify: _______________________________________________)

Campus:

_____Port Isabel High School _____Port Isabel Junior High School

Student Acknowledgement and Agreement

I understand that the Student Random Drug Testing Program is a prerequisite to participating in extracurricular activities and driving a vehicle to school. I acknowledge that I have received a copy or can access online the Point Isabel ISD policy that relates to the STUDENT RANDOM DRUG TESTING PROGRAM. I further acknowledge that I understand the provisions of the policy, and I hereby consent to any such testing as may be authorized by the District in accordance with said policy. I understand that because the tests are to be conducted on a random basis, I may be selected for testing more than once each year, and that refusal to submit to such tests may be grounds for discipline as specified in the policy.

Student’s signature: __________________________________________________________ Date: ______________________

Parent/Guardian Certification and Acknowledgement

I understand that the Student Random Drug Testing Program is a prerequisite to participating in extracurricular activities and driving a vehicle to school. I acknowledge that I have received a copy or can access online the Point Isabel ISD policy that relates to the STUDENT RANDOM DRUG TESTING PROGRAM, and I do hereby consent that my child may participate in any such testing as may be authorized by the District in accordance with said policy. I understand that I may withdraw the authorization for testing at any time upon submission of written notice to the school principal. I further understand and accept that, upon such withdrawal, my child will become ineligible to participate in any of the activities as may be specified in the policy until such time as authorization to test is restored.

Further, I hereby release and hold harmless the Point Isabel Independent School District and the testing service, and their trustees, officers, employees, agents, and representatives from any and all liability, claims, damages, and costs that may arise as a result of any action as may be taken relative to a positive drug/alcohol test.

Parent/Guardian signature: _______________________________________________ Date: ______________________

This form must be complete and submitted to the campus principal prior to participation in any extracurricular activity or being issued a student parking permit.

“PIISD does not discriminate on basis of race, color, national origin, sex, religion, age or disability in employment or provision of services, programs or activities.”

PARENT, STUDENT, and SCHOOL COMPACT

Point Isabel ISD and its staff members, the students and their parents, in an effort to improve student achievement and foster parental involvement, agree to the following:

The student: I, _____________________________, agree to:

• Be prepared and attend class each school day unless ill• Be cooperative and conduct myself in a courteous manner• Exhibit a positive attitude about learning and school• Complete all class work assigned• Use all hardware and software in a responsible way, and• Make a genuine attempt to master the skills taught• Develop a plan for post secondary education, and career.

The parent: I, ____________________________, agree to:

• Ensure my child attends school on a daily basis unless ill• Encourage my child and prepare him/her to be receptive of learning and discipline• Ensure my child participates in the appropriate school programs

(attend tutoring sessions,) when the need arises• Become familiar with the school, its programs, teachers and curricula• Attend parent-teacher conferences, parent workshops, and other school

functions in order to keep abreast of my child’s academic progress• Review my child’s test scores and records when needed, and• Communicate the learning needs of my child to school personnel.

We, the school and its staff members, agree to:

• Maintain an effective school climate and orderly classroom environment• Encourage parental participation in school activities• Provide rigorous curriculum and instruction in a supportive environment,

to prepare our students to success at the unlimited level• Assist students to enable them to meet the State of Texas(TAKS) and local

districts standards for student performance• Keep informed of the best methods, programs and established curricula• Keep parents informed in a clear, orderly manner, of the learning progress

of their child every 3 weeks• Discuss the student’s learning progress and needs with the student and

with the parent• Offer a number of opportunities for parental involvement including flexible

conference times, and• Offer a Title I Parent Orientation at the beginning of the school year.

This compact is for the 2017-2018 school year.

Student signature: _______________________________________________

Parent signature: _____________________________ Date: _____________

Staff Member ______________________________________________

Acknowledgment of Electronic Distribution of Student Handbook and Student Code of Conduct

My child and I have been offered the option to receive a paper copy or to electronically access at www.pi-isd.net the Point Isabel Independent School District Student Code of Conduct and the Campus Student Handbook.

I have chosen to:

□ Accept responsibility for accessing the Student Handbook and the Student Code of Conduct byvisiting the Web address listed above.

N

□ Receive a paper copy of the Student Handbook and the Student Code of Conduct.

I understand that the Student Handbook contains information that my child and I may need during the school year and that all students will be held accountable for their behavior and will be subject to the disciplinary consequences outlined in the Student Code of Conduct. If I have any questions regarding this Handbook or the Code, I should direct those questions to my child’s campus principal.

Printed name of student: ________________________________________________________________

Signature of student: ___________________________________________________________________

Signature of parent: ____________________________________________________________________

Date: ________________________________________________________________________________

“PI-ISD does not discriminate on basis of race, color, national origin, sex, religion, age or disability in employment or provision of services, programs or activities.”

“PI-ISD no discrimina a base de raza, color, origen nacional, religión, sexo, edad o discapacidad en empleo en la provisión de servicios o actividades.”

POINT ISABEL INDEPENDENT SCHOOL DISTRICT

Data Collection Form: Military Connected and Foster Care

Military Connected Student: Districts are required to collect data on “military-connected students” and report that data to the Texas Education Agency (TEA). The reported data is to include the number of active duty military-connected students and the number of National Guard or reserve military-connected students enrolled in a school district.

Please indicate one of the following:

[ ] 1. Student is a dependent of a member of the Army, Navy, Air Force, Marine Corps, or Coast Guard

on active duty.

[ ] 2. Student is a dependent of a member of the Texas National Guard (Army, Air Guard, or State

Guard).

[ ] 3. Student is a dependent of a member of a reserve force in the US military (Army, Navy, Air Force,

Marine Corps, or Coast Guard).

[ ] 4. Pre-kindergarten student is a dependent of a member of 1) an active duty uniformed member of

the Army, Navy, Air Force, Marine Corps, or Coast Guard, 2) activated/mobilized uniformed member of

the Texas National Guard (Army, Air Guard, or State Guard), or 3) activated/mobilized member of the

Reserve components of the Army, Navy, Air Force, Marine Corps, or Coast Guard; who are currently on

active duty or who were injured or killed while serving on active duty.

[ ] 5. None of the above

Foster Care Student: Districts are required to collect data on students in the conservatorship of the Department of Family and Protective Services (DFPS) currently, or for certain students that were previously in the conservatorship of DFPS.

Please indicate one of the following:

[ ] 1. Student is currently in the conservatorship of the Department of Family and Protective Services.

[ ] 2. Pre-kindergarten student was previously in the conservatorship of the Department of Family and

Protective Services following an adversary hearing held as provided by Section 262.201, Family Code.

[ ] 3. None of the above.

_________________________________________________________________________________________

Student’s Last Name First Name Middle Name Grade ID #

__________________________________________________________________________________________

Mother’s/Father’s/Guardian’s Name Signature of Parent or Guardian