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District Registration Form

LaFayette Central School District

5955 U.S. Route 20 West LaFayette, NY 13084

 

Telephone: 315-677-9728       Fax: 315-677-3372

www.lafayetteschools.org

STUDENT INFORMATION

Please complete all the information requested and check the appropriate spaces.

Last Name

First Name

Middle Name

Street Address

City

Zip

Residence Phone Number: 

Home Language

REGISTRATION INFORMATION

For School-Age Children Only

Previous School Attended and Address:

Phone Number:

School Entering

Entering into Grade

Transportation By

Has student ever attended LaFayette CSD ?

What years?

Has student ever received Special Education or Section 504 Services? *

Is student currently classified?

Was the student held out an extra year before entering Kindergarten?

Has the student been held back an extra year?

What grade?

Is the student receiving Academic Intervention/Support Services?

What services?

FAMILY BACKGROUND

Student lives with:

Do you have legal documentation of custody? 

Parent/Guardian deceased? 

Name of deceased: 

CUSTODIAL PARENT/GUARDIAN INFORMATION:
OTHER CHILDREN IN THE HOME:
EMERGENCY CONTACTS: List up to four (4) local emergency contacts who are available during school hours.
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McKinney-Vento Registration Form

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The answers to these residency questions and the information given will help us to determine the services that the student may be eligible to receive.

1) Is your current address a temporary living arrangement ? *

2) If yes, is this temporary arrangement due to loss of housing or economic hardship ?

3) Is this temporary arrangement voluntary ?

You answered YES to questions 1 AND 2, please complete the remainder of this form.

You answered No to question 1 or question 2, you may stop here and scroll down to the next section.

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STUDENT INFORMATION
HOUSING
ACKNOWLEDGEMENT
Current Signature
*

The District reserves the right to verify any and all information contained in the above form.

ETHNICITY
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TRANSPORTATION
*

LaFayette Central School District

ACKNOWLEDGEMENT
Current Signature
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Parent/Guardian Signature

According to the Final Regulations - Family Education Rights and Privacy Act (Buckley Amendment) dated June 17, 1976, it is no longer necessary to obtain written consent to release records between schools. It states that school officials, including teachers within an educational institution and officials of other schools in school systems in which the student may intend to enroll, may receive a student's record without a written consent for such a release.

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Release of Information Form

LaFayette Central School District

5955 U.S. Route 20 West LaFayette, NY 13084

 

Telephone: 315-677-9728         Fax: 315-677-3372  

www.lafayetteschools.org

www.lafayetteschools.org

5955 U.S. Route 20 West LaFayette, NY 13084

 

Telephone: 315-677-9728         Fax: 315-677-3372  

STUDENT INFORMATION

Please send the following information to the appropriate department(s) below so that a proper placement can be made on 

                  * Transcript/Report Cards

                * Guidance/Anecdotal Records

                * Attendance Reports

                * Psychological Evaluation

                * Standardized Test Scores/Regents Assessments

                * Academic Intervention Service Records

                * Health Records (including Immunizations)

                * Discipline Records

                * IEP/CSE Records

                * Birth Certificate

 

 

Central Registration

Attn: Paula Hibbert

Fax: 315-677-3372

phibbert@lafayetteschools.org

(Any Iep/CSE Paperwork)

Dept of Pupil Services

Attn: Patricia McElhannon

Fax: 315-677-3372

pmcelhannon@lafayetteschools.org

ACKNOWLEGEMENT
Current Signature
*
HOME LANGUAGE QUESTIONNAIRE

Dear Parent or Guardian, 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, as well as prior school and personal history. Please complete the sections below entitled Language Background and Educational History. Your assistance in answering these questions is greatly appreciated. Thank You.

Language Background

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

Specify if Other Checked

2) What was the first language your child learned?

3) What is the Home Language of each parent/guardian?

Mother

Father

Guardian

4) What language(s) does your child understand?

5) What language(s) does your child speak?

6) What language(s) does your child read?

7) What language(s) does your child write?

Educational History

8) Indicate the total number of years that your child has been enrolled in school:

9) Do you think your child may have any difficulties or conditions that affect his or her ability to understand, speak, read or write English or any other language?

You answered Yes or Not Sure - please explain below:

How severe do you think those difficulties are?

10a) Has your child ever been referred for a special evaluation in the past?

You answered yes, please complete 10b below:

10b) If referred for an evaluation, has your child ever received any special education services in the past?

Age at which services where received (check all that apply):

11) If there anything else you think is important for the school to know about your child, please indicate below:

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

10c) Does your child have an individualized Education Program (IEP)?

OFFICIAL ENTRY ONLY
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