Date of Birth        

All students between 5 and 21 years of age have the right to a free public education. Children may not be refused admission because of race, color, creed or national origin, sex, citizenship, handicapping condition, or immigration status.

The Ithaca City School District requires the collection and recording of the ethnic identity of students in the Ithaca City School District in accordance with the Federal categories and definitions. The information will be used to:

           *  Report information to the State and Federal Education Departments.

           *  Plan educational programs and make sure they are readily available to all students.

           *  Analyze differences in the academic performance, attendance and completion of school.

The Ithaca City School District understands the sensitive nature of this information and wishes to assure you the your answers to the following two (2) questions will be kept secure and confidential in accordance with all State and Federal privacy laws and regulations.

Is the student Hispanic, Latino, or of Spanish origin? 

In order to provide your child with the best possible education, we need to determine how well they understand, speak, read and write in English.

Consent & Authorization for Media Purposes

Engaged students are successful students. Critical to our mission is the ability to communicate, through media outlets, the excellence that occurs in the Ithaca City School District (the "District") every day.

Please indicate your consent and authorization below:

This Consent and Authorization shall be interpreted to meet the requirements of the New York Civil Rights Law for the use of my child and their likeness.  I hereby release and discharge the district and its officers, employees, agents, representatives, and students from all claims and liability arising out of or in connection with the activities I have authorized above, including but not limited to any claims for defamation, invasion of privacy, right of publicity, or any similar causes of action.

Signature of Parent/Legal Guardian  (use mouse to sign)

Date

Name of Parent/Legal Guardian

Has your child ever attended school?

Is your child a High School Graduate? 

IF YES - YOUR ENROLLMENT PROCESS HAS ENDED - PLEASE HIT THE SUBMIT BUTTON AND THEN CONTACT THE REGISTRAR AT 607-274-2201

Please Complete for Last School Attended:

District Name:

Previous School Name

Previous School Address

 City                    State             Zip

Previous School Phone

Last Date Of Attendance

Is this student a foreign exchange student?

In previous school did student receive Special Education with an Individualized Education Program (IEP)?

In previous school did student have a 504 Plan?

In previous school did student receive  Academic Intervention Services or Support (sometimes called RTI, AIS or Title 1)?

In previous school did student receive support for English as a Second Language (ESL) or English as a New Language (ENL)?

Where is the student currently living? 

The answer you give to the following question will help the district determine what services you or your child may be able to receive under the McKinney-Vento Act. Students who are protected under the McKinney-Vento Act are entitled to immediate enrollment in school even if they don't have the documents normally needed, such as proof of residency, school records, immunization records, or birth certificate. Students who are protected under the McKinney-Vento Act may also be entitled to free transportation and other services.  Your answer will be kept confidential and will only be shared with those staff responsible for providing services to the student and those responsible for keeping track of how many students are identified as living in temporary housing.

Check one or more groups from the following list that best describes your child's race:

Will this student be utilizing Ithaca City School District Transportation (if available)?

Does this student have a parent/legal guardian on Active Duty in the Armed Forces?

I give the District and its schools permission to take photographs of my child and/or to record brief audio, video and/or digital footage of my child in programs and activities sponsored by the District and to disclose such photographs, audio or video footage to third parties for the purposes of highlighting my child's success and/or engagement in District-sponsored activities.

I do not give the District and its schools permission to take photographs of my child and/or to record brief audio, video and/or digital footage of my child in programs and activities sponsored by the District and to disclose such photographs, audio or video footage to third parties for the purposes of highlighting my child's success and/or engagement in District-sponsored activities.

Has your child ever attended ICSD ?

Please Describe

 Please make sure you submit the Student Transportation Request Form on the Registration page.

Student Registration Form

Name of Parent/Legal Guardian

What language(s) is(are) spoken in the student's home or residence?

What was the first language your child learned?

What is the Home Language of each parent/guardian?

What language(s) does your child understand?

What language(s) does your child speak?

What language(s) does your child read?

What language(s) does your child write?

In what language(s) would you like to receive information from the school?

Last Name

First Name

Middle Name

Date of Birth

Street Address

City

State

Zip

Street Address

City

State

Zip

Language Background  (Please check all that apply)

Before submitting form, please verify your answers on all pages. Moving back to other pages will not erase your work. After pressing SUBMIT FORM, if there are errors, they will be noted in red.

Relationship to Student

Relationship to Student

If yes, check the area(s) in which support was provided:

Grade Entering

(Hispanic, Latino, or of Spanish origin means a person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race.)

A person having origins in any of the original peoples of North and South America (including Central America) and who maintains cultural identification through tribal affiliation or community recognition (e.g. Cherokee, Mohawk,  Inuit).

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.

A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

A person having origins in any of the black racial groups of Africa.

A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.

Name(s) of Parent(s)/Legal Guardian(s) in the Armed Forces

If born outside of the United States (including Puerto Rico), has the student previously attended school in the United States (including Puerto Rico)?

Phone Number

Email

Please include a phone number and/or an email address in case the registrar's office needs to contact your with questions about your student's registration forms.

400 Lake Street • P.O. Box 549 • Ithaca, New York • 14851-0549

ITHACA CITY SCHOOL DISTRICT