Pearsall Independent School District Registration Form for ......Occasionally, Pearsall ISD wishes...

Student I.D #

Student Full Legal Name Grade Level Social Security Number

Gender Date of Birth Birth Place Age (Sept. 1, 2020

Home Phone: Will your child be using bus transportation to get to school?

Guardian:Address:City, State, Zip:Employer:Cell:

Relation:

Home: Bus:

Pearsall Independent School District Registration Form for School Year 2020 - 2021 _____Ted Flores Elementary 830-334-4108 _____Pearsall Jr. High 830-334-8021

_____Pearsall Intermediate 830-334-3316 Student Information _____Pearsall High School 830-334-8011

Parent Information

No

Name:

Phone Preference: Cell/Home/Business/Other

Relation: Cell: Home: Bus:

Name:

Phone Preference: Cell/Home/Business/Other

Doctor Preference: Phone: Dentist Preference: Phone:

Hospital Preference: Phone: Other Medical: Phone:

List any allergies:

Brothers/Sisters Grade SchoolSibling Information

Brothers/Sisters Grade School

The above information is required for a permanent school record of your child and will be used by school personnel. Presenting false documents, records or information is a violation of state law and may subject you to tuition cost for your child. I certify that the information given above is correct. I authorize the school to contact the person named on this form and the above named physician to render such treatment as may be necessary in an emergency of said child. In the event parents, physician, or other persons named cannot be contacted, school officials are hereby authorized to take whatever action is necessary in their judgement for the health of the above child. I will not hold the school district financially responsible for emergency care and/or transportation.

Parent or Guardian Signature Date of Birth Date

(For Office Use Only)Teacher Name:Birth Certificate on File: PK Par Mil: PK Foster:Soc Sec Copy on File: At Risk: Migrant:Gift: LEP: BIL: ESL: Par Per: Econ:

Control No.: Eligibility Code:Immunization on File: Title I:Hm Lng:Special Education: Prim: Sec: Tert: Multi:

1. Guardian:Address:City, State, Zip:Employer:Cell:

Relation:

Home: Bus:

2.

3.

4.

Yes

Phone Preference: Cell Home Business Phone Preference: Cell Home Business

Svc. Branch: Rank:

Lang. for Mailouts: English SpanishReceive Mailouts: Y N Lang. for Mailouts: English SpanishReceive Mailouts: Y N

Email: Email:

Svc. Branch: Rank:

Emergency Contact Information(Add someone other than guardians listed above.)

Relation: Cell: Home: Bus:

Drivers License #________________ Drivers License #_________________

PhysicalAddress: Mailing Address: Previous School Attended

PEARSALL INDEPENDENT SCHOOL DISTRICT

STUDENT PICK UP FORM

SCHOOL YEAR 2020-2021

___Ted Flores Elementary ___Pearsall Intermediate ___Pearsall Jr High ___Pearsall High

Grade: ___________

STUDENT NAME ____________________________________________________MALE______FEMALE______

ADDRESS ________________________MAILING__________________CITY ______________ZIP____________

FATHER’S NAME_______________________________ PHONE# _______________WORK#_________________

MOTHER’S NAME ______________________________ PHONE# ______________WORK#_________________

LEGAL GUARDIAN _____________________________ PHONE# _______________WORK#_________________

Please list and provide contact numbers of adults whom you AUTHORIZE to Pick Up/Sign Out your child.

Please keep in mind that ONLY the people listed will be allowed to check out/pick up your child.

1. Name_________________________________Relation______________Ph.__________________Wk____________






USE OF STUDENT WORK IN DISTRICT PUBLICATIONS:

Occasionally, Pearsall ISD wishes to display or publish student artwork, photos taken by the student, or other

original work on the district’s website, a website affiliate or sponsor by the district, such as a campus or classroom

website, and in district publication. The district agrees to only use these student projects in this manner.

___ Yes, I give permission to use my child’s artwork, photos, or other original work in the manner described above.

___ No, I do not give permission to use my child’s artwork, photos, or other original work in the manner described above.

PARENT STATEMENT PROHIBITING CORPORAL PUNISHMENT:A parent has the responsibility of submitting a signed statement to the principal each year if he or she chooses to prohibit the use of corporal punishment with his or her child. A parent may reinstate permission to use corporal punishment at any time during the school year by submitting a signed statement to the principal. Corporal punishment will be administered in accordance with the law, district policy, and the Student Code of Conduct (SCOC). [See FO and the SCOC]

___Yes ___ No I (do / do not) prohibit the use of corporal punishment with my child.

_______________________________________________________________________________________________Parent/Guardian Signature Date

Pearsall Independent School District Pearsall, Texas 78061

Learning Today…. Leading Tomorrow

TRANSCRIPT REQUEST

DATE: _______________________

PREVIOUS SCHOOL NAME: _____________________________________

ADDRESS: _____________________________________

_____________________________________

_____________________________________

Student Name Grade Date of Birth

This student has enrolled in our school. Please send us the records listed below for this student:

O Transcripts with earned creditsO Grades earned during the current year to dateO Achievement/STAAR/ test scoresO Immunization recordsO Records of attendanceO Copy of Birth CertificateO Social Security numberO Any programs (Special Education, ESL, Gifted/Talented

Chapter I Reading/ Math) O Other ________________________________

Please release all information to Pearsall Independent School District.

___________________________________ ___________________________ Parent Signature Date

“An equal Opportunity Employer”


Acknowledgement Form 2020-2021 School Year

Student Name_______________________________ Grade_____ Campus______________

Please read and initial

Acknowledgement of Electronic Distribution of Student Handbook & Student Code of Conduct

___ I accept the responsibility for accessing the Student Handbook & Student Code of Conduct that is available on the Pearsall ISD website www.pearsallisd.org I understand that the 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 the handbook or the Code of Conduct, I should direct those questions to the campus principal.

Notification of Rights under FERPA for Elementary and Secondary Schools

___ I understand the Rights under FERPA information is located on the district website www.pearsallisd.org. If you do not want your child’s information used for school-sponsored purposes please submit a written consent within ten days after enrollment.

Notification Regarding Directory Information and Parent’s Response Regarding Release of Student Information ___ According to state and federal law, 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 Pearsall Independent School District 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/children first day of instruction for the school year. PISD encourages parents to use the form available on the district’s website as the written notification. The form is OPTIONAL and located on our district’s website www.pearsallisd.org. If you do not want your child’s information used for school-sponsored purposes please submit a written consent within ten days after enrollment.

Parent’s Objection to the Release of Student Information to Military Recruiters and Institutions of Higher Education

(Applicable to secondary grade levels only)

___ Federal law requires that the district release to military recruiters and institutions of higher education, upon request, the name, address, and telephone number of secondary school students enrolled in the district, unless a student’s parent or eligible student directs the district not to release information to these types of requestors without prior written consent. The OPTIONAL form is located on our district’s website www.pearsallisd.org. If you do not want this information released you have ten days after enrollment to submit the form to your child’s school.

_____________________________________________________________________________________ Parent/Guardian Name Signature Date

http://www.pearsallisd.org/http://www.pearsallisd.org/http://www.pearsallisd.org/http://www.pearsallisd.org/

By making your child/children’s school attendance a priority, you will be taking an important step in supporting your child/children’s educational SUCCESS. REMEMBER EVERY DAY COUNTS!

Student Information

Student_____________________________ Grade_____ TFE PIS PJH PHS





IMPORTANT Please read and initial:

_____ No more than 5 parent notes will be accepted per semester, anything after will be

considered unexcused. After the 5th parent note a Doctor’s note must be submitted. ALL

excuses/notes MUST be submitted within 3 days of the absence or it will be unexcused.

However we will waiver the Doctor’s/Funeral excuses/notes.

_____ Once the student has 3 unexcused absences the parent will receive a warning letter and a

conference request by the truancy officer. After the 6th unexcused absence the parent will

receive a letter and a conference request by the administrator. If the student has 9

unexcused absences the parent will receive a letter and a conference requested by the

administrator and the truant officer. After that further action will be taken.

_____ I have accepted the responsibility for accessing the district attendance policies on the

district’s website at www.pearsallisd.org

Signature of Parent/Guardian__________________________________ Date _____________

PEARSALL INDEPENDENT SCHOOL DISTRICT 2020-2021

Attendance Information Form

http://www.pearsallisd.org/

PEARSALL INDEPENDENT SCHOOL DISTRICT HEALTH SERVICES

PARENT: PLEASE PROVIDE US WITH THE INFORMATION REQUESTED BELOW AND RETURN TO THE SCHOOL NURSE AS SOON AS POSSIBLE.

1. Student’s Name: Date of Birth: _____________________

Grade: _____Teacher: ________________ Home Phone: _______________ Cell Phone: _______________

Home Address: __________________________ Mailing Address: _________________________________

Last school(s) attended: ___________________________________________________________________

2. Parent’s Name/Place of Employment:Father’s Name: ______________________Employment: ___________________ Phone: _______________Mother’s Name: _____________________Employment: ___________________ Phone: _______________

3. Who to contact in case parents are not available:Name: _____________________________Address: _______________________Phone: _______________Name: _____________________________Address: _______________________Phone: _______________

********************************************************************************************* 4. Does your child have asthma as diagnosed by a physician? Yes No

Has your child had any allergic reactions to medications, foods or insects? Yes No

If yes, to either both questions please indicate medication prescribed: _______________________________

5. Does your child have a seizure disorder diagnosed by a doctor? Yes NoIf yes, please indicate medication prescribed? __________________________________________________

6. Please list any other health conditions about your child that you feel we at the school need to know about

_______________________________________________________________________________________

_______________________________________________________________________________________7. In case of an accident and in the event I cannot be reached immediately by phone, I hereby authorize a

representative of the Pearsall Independent School District to refer my child to Dr._____________________,or if said physician cannot be reached, then refer to Dr. ___________________.

____________________________________________ ________________________________ Parent/Guardian’s Signature Date

THE ABOVE INFORMATION WILL BE SHARED WITH THE PRINCIPAL’S OFFICE AND STUDENT’S TEACHERS.

April 2018

IMMUNIZATION REGISTRY (ImmTrac2)Minor Consent Form(Please print clearly)

Privacy Notification: With few exceptions, you have the right to request and be informed about information that the State of Texas collects about you. You are entitled to receive and review the information upon request. You also have the right to ask the state agency to correct any information that is determined to be incorrect. See http://www.dshs.texas.gov for more information on Privacy Notification. (Reference: Government Code, Section 552.021, 552.023, 559.003, and 559.004)

Upon completion, please fax or mail form to the DSHS ImmTrac2 Group or a registered Health-care provider.Questions? (800) 252-9152 • (512) 776-7284 • Fax: (866) 624-0180 • www.ImmTrac.comTexas Department of State Health Services • ImmTrac2 Group – MC 1946 • P. O. Box 149347 • Austin, TX 78714-9347

PROVIDERS REGISTERED WITH ImmTrac2: Please enter client information in ImmTrac2 and affirm that consent has been granted. DO NOT fax to ImmTrac2. Retain this form in your client’s record.

Stock No. C-7 Revised 03/2017

ImmTrac2, the Texas immunization registry, is a free service of the Texas Department of State Health Services (DSHS). The immunization registry is a secure and confidential service that consolidates and stores your child’s (younger than 18 years of age) immunization records. With your consent, your child’s immunization information will be included in ImmTrac2. Doctors, public health departments, schools and other authorized professionals can access your child’s immunization history to ensure that important vaccines are not missed.

The Texas Department of State Health Services encourages your voluntary participation in the Texas immunization registry.

Consent for Registration of Child and Release of Immunization Records to Authorized Entities I understand that, by granting the consent below, I am authorizing release of the child’s immunization information to DSHS and I further understand that DSHS will include this information in the state’s central immunization registry (“ImmTrac2”). Once in ImmTrac2, the child’s immunization information may by law be accessed by:

• a public health district or local health department, for public health purposes within their areas of jurisdiction;• a physician, or other health-care provider legally authorized to administer vaccines, for treating the child as a patient;• a state agency having legal custody of the child;• a Texas school or child-care facility in which the child is enrolled;• a payor, currently authorized by the Texas Department of Insurance to operate in Texas, regarding coverage for the child.

I understand that I may withdraw this consent to include information on my child in the ImmTrac2 Registry and my consent to release information from the Registry at any time by written communication to the Texas Department of State Health Services, ImmTrac2 Group – MC 1946, P. O. Box 149347, Austin, Texas 78714-9347.By my signature below, I GRANT consent for registration. I wish to INCLUDE my child’s information in the Texas immunization registry.Parent, legal guardian, or managing conservator:

Printed Name

SignatureDate

*Children younger than 18 years old only. Child’s Gender: Male FemaleChild’s Date of Birth

Child’s Address Apartment # Telephone--

Child’s Last Name

City State Zip Code County

Mother’s First Name Mother’s Maiden Name

Child’s Middle NameChild’s First Name

http://www.dshs.texas.govhttp://www.ImmTrac.com

TB Questionnaire

Name of Child____________________________________________________________Date of Birth ________________

Organization administering questionnaire_Pearsall I.S.D _______________________ 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 that 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)

Pearsall Independent School District

Texas Education Agency Texas Public School Student/Staff Ethnicity and Race Data Questionnaire

The United States Department of Education (USDE) requires all state and local education institutions to collect data on ethnicity and race for students and staff. This information is used for state and federal accountability reporting as well as for reporting to the Office of Civil Rights (OCR) and the Equal Employment Opportunity Commission (EEOC). School district staff and parents or guardians of students enrolling in school are requested to provide this information. If you decline to provide this information, please be aware that the USDE requires school districts to use observer identification as a last resort for collecting the data for federal reporting. Please answer both parts of the following questions on the student’s or staff member’s 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/Latino

Part 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 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.

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:

Hispanic / Latino

Not Hispanic/Latino

Race – choose one or more: American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White

Observer signature: Campus and Date:

Texas Education Agency – March 2017

Agencia de Educación de Texas Cuestionario de Información de Datos Raciales y de Etnicidad de Estudiantes/Miembros de Personal de

las Escuelas Públicas de Texas

El Departamento de Educación de Estados Unidos (USDE) requiere que todas las instituciones estatales y locales de educación, recopilen datos sobre etnicidad y raza de los estudiantes y de miembros de personal. Esta información es utilizada para los reportes estatales y federales así como para reportar a la Oficina de Derechos Civiles (OCR) y a la Comisión de Igualdad en el Empleo (EEOC). Al personal del distrito escolar y los padres o representante legal de estudiantes que deseen matricularse en la escuela, se le requiere proporcionar esta información. Si usted rehúsa proporcionarla, es importante que sepa que el USDE requiere que los distritos escolares usen la observación para identificación como último recurso 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 de personal. 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/Latino

Parte 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 que mantiene 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 y Vietnam. Negro o Áfrico-Americano – Una persona con orígenes de cualquier grupo racial negro de África. Nativo de Hawai u otras islas del pacífico – Una persona con orígenes o de personas originarias de Hawai, Guam, Samoa u otras Islas del Pacífico. Blanco – Una persona con orígenes de personas originarias de Europa, el Medio Este o el Norte de África.

__________________________________ __________________________________

Nombre del Estudiante/Miembro de Personal Firma (Padre/Representante legal) (por favor use letra de imprenta) /(Miembro de personal

__________________________________ ___________________________________ Número de Identificación del Fecha Estudiante/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:

Hispanic / Latino Not Hispanic/Latino

Race – choose one or more: American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White

Observer signature: Campus and Date: Agencia de Educación de Texas – Marzo 2017

Distrito Escolar Independiente de Pearsall

Revised on Oct. 29, 2014 parts used from revisions by THEO on April 27, 2009 & PEIMS Status Template on August 24, 2012.

2020 – 2021 Pearsall ISD Student Residency Questionnaire PLEASE COMPLETE (1) ONE FORM FOR EACH STUDENT BEING ENROLLED

Name of Student: Grade:

Current Address: (include City, State, and Zip) Telephone #:

Cell Home Work No phonePrevious Address: (include City, State, and Zip) County:

Last School Attended: Ted Flores Elementary Pearsall Intermediate Pearsall Jr. High Pearsall High School

Other: ________________________________________________________________________

Last Date Attended: May 2020 Other: _______________________________

Name of Person with whom student resides: Student lives with one parent or both parents every day of the school year. [C192=3] Student lives with a legal guardian (appointed by a court) every day of the school year.[C192=3] Student is under 21 on September 1 of the 2020-2021 school year and does not live with a parent or legal guardian. [C192=4] If this statement is selected, please mark one of the two choices below:

Caregiver (Examples: friends, relatives, parents of friends) Unaccompanied Student [C192=4]

Student is currently in the conservatorship (custody) of the Department of Family and Protective Services (court order) Student is currently in Foster Care and residing in a Foster or Group Home (Foster Parent/Group Home Staff have a DFPS Placement Authorization Form 2085)

X Signature of Person Providing Information (Parent/Legal Guardian/Caregiver/Unaccompanied Student)

Date:

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).

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.

1. “X” all boxes below that best describe where the student sleeps at night, leave those blank that do not apply:o In a home that the student’s parent or legal guardian owns or rents [C189=0]o In a place that does not have windows, doors, running water, heat, electricity, or is overcrowded [C189=3]o Staying with a friend or relative because of loss of housing, economic hardship, or a similar reason (examples: eviction, foreclosure,

fire, flood, lost job, divorce, domestic violence, kicked out by parents, ran away from home) [C189=2]o In a shelter (examples: living in a family shelter, domestic violence shelter, children/youth shelter, FEMA housing) [C189=5]o In an unsheltered location, such as a tent, a car or truck, a van, an abandoned building, on the streets, at a campground, in the park,

in a bus or train station, or other similar place [C189=3]o In a hotel or motel because of loss of housing or economic hardship (examples: eviction, foreclosure, cannot get deposits for

permanent home, flood, fire, hurricane) [C189=4]o In a transitional housing program (housing that is available as part of a program for a specific length of time only and is partly or

completely paid for by a church, a nonprofit organization, governmental agency, or another organization) [C189=5]o The student lives here because of a natural disaster. “X” the type of disaster below and provide the requested information:

Flood Tornado Wildfire Hurricane Other—Please describe: __________________________________________o The student does not sleep in any of the places described above. Tell below where the student does sleep:

_________________________________________________________________________________________________________

2. Please provide the following information:Names(s) of school-aged siblings

(brothers and/or sisters) of the student Grade Brother (B)

Sister (S) Stays at the same place as student

List all other school-aged children that stay in the same

place as the student

Grade

B S Yes No B S Yes No B S Yes No B S Yes No B S Yes No

DISTRICT USE ONLY I certify the above named student qualifies or does NOT qualify for the Child Nutrition Program under the provisions of the McKinney-Vento Act. Signature/Date of McKinney-Vento/Foster Care Liaison:

Copying/Filing Instructions: Copy to: Parent at Registration or Enrollment Original: File in Student Residency Questionnaire (SRQ) Folder for future audit only if first in #1 is . Original: If more than one box is , scan via e-mail to the District McKinney-Vento Liaison immediately for follow-up. The campus should keep the original at front of SRQ Folder along with the signed copy returned by the District McKinney-Vento Liaison.

DO NOT file SRQs in individual Permanent Record folders. This form should remain CONFIDENTIAL at ALL TIMES.

Revised on Oct. 29, 2014 parts used from revisions by THEO on April 27, 2009 & PEIMS Status Template on August 24, 2012.

2020 - 2021 Cuestionario De Residencia Para El estudianteFAVOR DE LLENAR (1) UNA FORMA POR CADA ESTUDIANTE QUE ESTA INSCRIBIENDO

Nombre de estudiante Grado:

Direccion: (Ciudad, Estado, y Codigo Postal) Telefono #:

Celular Hogar Trabajo No telefonoDireccion anterior: (Ciudada, Estado, y Codigo Postal) Condado

Ultima escuela que estuvo: Ted Flores Elementary Pearsall Intermediate Pearsall Jr. High Pearsall High School

Other: ________________________________________________________________________

Ultimo dia que fue: May 2020

Other:__________________________

____ Nombre de la persona con quien vive el estudiante:

Estudiante vive con uno o ambos padres todos los dias del ano escolar Estudiante vive con el guardian legal (designado por la corte) Estudiante es menor de edad en la fecha del 21 de Septiembre 2020-2021 ano escolar y no vive con un padre o guardian legal. Marque “X” en una de las opciones:

Cuidador (Ejemplos: amigo, familiar, padres de amigos) Estudiante no esta acompanado

El estudiante esta actualmente en la custodia del Departamento de Familia Y Servicios de Proteccion (orden judicial) Estudiante esta actualmente viviendo en un hogar sustituto (Guardian Sustituto/ Temporal o Empleado del Hogar Sustituto tienen un Forma 2085: Authorizacion para Hogar Sustituto)

X Firma de la persona dando la informacion (padre, guardian legal, cuidador)

Fecha:

Presentar un falso registro o falsificacion de registros es un delito en virtud de le Seccion 37.10, codigo Penal, y la matriculacion de los ninos en documentos falsos los temas que la persona con la responsabilidad de la matricula y otros gastos. TECSec. 25.008 (3)(d).

La informacion en este cuestionario se require para cumplir con los requisitos establecidos en la ley McKinney-Vento Education Act 42 U.S.C.1143a(2) y de la legislacion require que las escuelas para recopilar datos, a la guarda de todos los estudiantes. Las respuestas a esta residencia informacion ayudara a determinar los servicios que el estudiante puede ser elegible para recibir.

1. “X” Marque lo que applique al estudiante sobre la situacion de donde vive.o Viviendo con padre/guardian legal en casa, apartamento o vivienda sin compartir el hogar con cualquier orta familiao Viviendo en una tienda de campana, automovil,van,edificio abandonado (viviendo en calles, campamento, lugar sin techo), incluye

vivir en casa o apartamento que no tiene electricidad, calefaccion. y/o agua corrienteo Viviendo en la casa de un amigo o familiar porque perdi a mi vivienda (con mas de una familia, debido a dificultades economicas,

incendios, inundaciones, perdida de empleo, divorcio, violencia domestica, padre en el ejercito y fue enviado, padre en la carcel, etc.)o Viviendo en un refugio porque no tengo una vivienda permanente ( refugio de familia, refugio de violencia domestica, albergue de

ninos/ jovenes, vivienda de FEMA), incluye vivir en viviendas transitorias (moverse de un lugar a otro, arreglo de vida temporal)o Viviendo en un hotel o motel (debido a las dificultades economicas, los desalojos, inundaciones, incendios, huracanes, etc.)o En una habitacion de transicion (vivienda proveida solamente por un periodo de tiempo especifico, pagada parcialmente o de manera

completa por una iglesia u otra organizacion de asistencia al public)o El estudiante vive aqui por desastres naturales. Marque “X” en el tipo de desastre: Inundacion Tornado Incendio Huracan Otra—por favor explique: ____________________________________

o Estudiante no vive en ninguna situacion mencionada. Explique donde vive el estudiante.

2. Por favor de la sigiuente informacion:Nombres de hermanos/ hermanas del

estudiate de edad escuelante Grado Hermano (O)

Hermana (A) Vive en el

mismo lugar que el

estudiante

Liste todo otro nino (a) de edad escuelante que vive en el mismo lugar que el estudiante

Grado

O A Si No O A Si No O A Si No O A Si No O A Si No

PARA USO DEL DISTRICTO SOLAMENTE Certifico que el estudiante mencionado en este formulario Califica No Califica para el Programa de Nutricion en la escuela bajo los requisitos del Acta McKinny-Vento.. Firma del official McKinney-Vento/Foster Care Fecha

Copying/Filing Instructions: Copy to: Parent at Registration or Enrollment Original: File in Student Residency Questionnaire (SRQ) Folder for future audit only if first in #1 is . Original: If more than one box is , scan via e-mail to the District McKinney-Vento Liaison immediately for follow-up. The campus should keep the original at front of SRQ Folder along with the signed copy returned by the District McKinney-Vento Liaison.

DO NOT file SRQs in individual Permanent Record folders. This form should remain CONFIDENTIAL at ALL TIMES.

Socioeconomic Information Form

*CONFIDENTIAL

Student Name _____________________________ Student Grade ______Student Date of Birth __________________

School Name ______________________________ Student ID _________________

Pearsall ISD is required to collect and report the socioeconomic status of each student to the Texas Education Agency for

purposes of the annual state accountability ratings and for federal reporting. Please note that this form is not sent to the Texas

Education Agency and that the income levels indicated for your family are not reported to the Texas Education Agency. Only the

Economic Disadvantaged status of each student as determined by the information provided is reported to the Texas Education

Agency.

SECTION A

Do you receive Supplemental Nutrition Assistance (SNAP)? Yes No Do you receive Temporary Assistance to Needy Families (TANF)? Yes No

If you answered YES on either of the above, skip SECTION B and continue to the SIGNATURE section.

SECTION B (Complete only if all answers in SECTION A are NO)

How many members are in the household (include all adults and children)? ____________

TOTAL YEARLY INCOME BEFORE DEDUCTIONS OF ALL HOUSEHOLD MEMBERS (check one box below):

Include wages, salary, welfare payments, child support, alimony, pensions, Social Security, worker’s

$0 – 21,590 $44,124 – 51,634 $74,168 – 81,678 $104,212 – 111,722 $21,591 – 29,101 $51,635 – 59,145 $81,679 – 89,189 $111,723 – 119,233 $29,102 – 36,612 $59,146 – 66,656 $89,190 – 96,700 $119,234 – 126,744 $36,613 – 44,123 $66,657 - 74,167 $96,701 - 104,211 $126,745 and more

compensation, unemployment and all other sources of income (before any type of deductions)

SIGNATURE Please check one of the following two boxes as appropriate. In accordance with the provisions of the Protection of Pupil Rights Amendment (PPRA) no student shall be required, as part of any

program funded in whole or in part by the U.S. Department of Education, to submit to a survey, analysis, or evaluation that reveals

information concerning income (other than that required by law to determine eligibility for participation in a program or for receiving

financial assistance under such program), without the prior written consent of the adult student, parent or legal guardian.

I certify that all the information on this form is true and that all income is reported. I understand the school will receive federal funds and will be rated for accountability based on the information I provide.

I choose not to provide this information. I understand that the school’s disbursement of federal funds and accountability rating may be affected by my choice.

Parent/Guardian Name (Print) Parent/Guardian Signature Date

PEARSALL INDEPENDENT SCHOOL DISTRICT2020 - 2021

Distrito Escolar Independiente de Pearsall Formulario de Información Socioeconómica

**CONFIDENCIAL **

Nombre del estudiante _____________________________ Grado ______ Fecha de Nacimiento __________________ Nombre de la escuela ______________________________ identificación del estudiante _________________

Pearsall I.S.D. está obligado a recoger y reportar la situación socioeconómica de cada estudiante a la Agencia de Educación de Texas para los propósitos de las calificaciones escolares estatales anuales y para reportes federales. Tenga en cuenta que este formulario no se envía a la Agencia de Educación de Texas y que los niveles de ingresos indicados para su familia no son reportados a la Agencia de Educación de Texas. Sólo el estado de escasos recursos económicos de cada estudiante según lo determinado por la información proporcionada se informa que la Agencia de Educación de Texas.

SECCIÓN A ¿Recibe usted Asistencia de Nutrición Suplementaria (SNAP)? ___Sí ___No ¿Usted recibe Asistencia Temporal para Familias Necesitadas (TANF)? ___Sí ___No

Si su respuesta es SÍ a cualquiera de los anteriores, no tome SECCIÓN B y continuar a la sección FIRMA.

SECCIÓN B (Complete sólo si todas las respuestas en la sección A son NO) ¿Cuántos miembros hay en el hogar (incluya todos los adultos y niños)? ____________ INGRESO ANUAL TOTAL DE ANTES DE DEDUCCIONES DE TODOS LOS MIEMBROS DEL HOGAR (marque una casilla a continuación): Incluya sueldos, salarios, prestaciones sociales, sustento de menores, pensión alimenticia, pensiones, Seguridad Social, del trabajador de la indemnización, el desempleo y todas las otras fuentes de ingresos (antes de cualquier tipo de deducciones)

FIRMA. De conformidad con lo dispuesto en la Protección de los Derechos del Alumno (PPRA) se exigirá a ningún estudiante, como parte de un programa financiado en su totalidad o en parte por el Departamento de Educación de EE.UU., para someterse a una encuesta, análisis o evaluación que revela la información relativa a los ingresos (que no sea la requerida por la ley para determinar la elegibilidad para participar en un programa o para recibir ayuda financiera bajo tal programa), sin el previo consentimiento por escrito del estudiante adulto, padre o tutor legal.

___Yo certifico que toda la información en este formulario es verdadera y que he reportado todos los ingresos. Entiendo que la escuela recibirá fondos federales y será clasificado para la rendición de cuentas sobre la base de la información que proporcione.

_____________________________________________________________________________________________ Nombre del Padre Firma del Padre Fecha

$0-$21,590$21,591-$29,101$29,102-$36,612 $36,613-$44,123

$44,124-$51,634$51,635-$59,145$59,146-$66,656$66,657-$74,167

$74,168-$81,678$81,679-$89,189$89,190-$96,700$96,701-$104,211

$104,212-$111,722$111,723-$119,233$119,234-$126,744$126,745 y mas

Texas Education Agency Special Populations Division 2017-2018│ 141

Language Proficiency Assessment Committee (LPAC)

Pearsall INDEPENDENT SCHOOL DISTRICT/CHARTER SCHOOL

HOME LANGUAGE SURVEY-19 TAC Chapter 89, Subchapter BB, §89.1215 (Home Language Survey applicable ONLY if administered for students enrolling in pre-kindergarten through grade 12)

TO BE COMPLETED BY PARENT OR GUARDIAN FOR STUDENTS ENROLLING IN PREKINDERGARTEN THROUGH GRADE 8 (OR BY STUDENT IN GRADES 9-12): The state of Texas requires that the following information be completed for each student who enrolls in a Texas public school for the first time. It is the responsibility of the parent or guardian, not the school, to provide the language information requested by the questions below.

NAME OF STUDENT: ______________________________ STUDENT ID#: _______________________________

ADDRESS: _______________________________________ TELEPHONE #: _______________________________

CAMPUS: ________________________________________ NOTE: PLEASE INDICATE ONLY ONE LANGUAGE PER RESPONSE.

1. What language is spoken in the child’s home most of the time? ________________________

2. What language does the child speak most of the time? ________________________

_______________________________________ ________________________________ Signature of Parent/Guardian Date

_______________________________________ ________________________________ Signature of Student if Grades 9-12 Date

Dear Parent or Guardian:

To determine if your child would benefit from Bilingual and/or English as a Second Language program services, please answer the two questions below.

If either of your responses indicates the use of a language other than English, then the school district must conduct an assessment to determine how well your child communicates in English. This assessment information will be used to determine if Bilingual and/or English as a Second Language program services are appropriate and to inform instructional and program placement recommendations. Once your child is assessed, changes to the Home Language Survey responses are not permissible.

If you have questions about the purpose and use of the Home Language Survey, or you would like assistance in completing the form, please contact your school/district personnel.

For more information on the process that must be followed, please visit the following website: http://web.esc20.net/LPAC-Interactive/InteractiveFlowchart-EN.htm.

This survey shall be kept in each student’s permanent record folder.

http://web.esc20.net/LPAC-Interactive/InteractiveFlowchart-EN.htm

Texas Education Agency Special Populations Division 2017-2018│ 142

Language Proficiency Assessment Committee (LPAC)

Pearsall INDEPENDENT SCHOOL DISTRICT/CHARTER SCHOOL

Cuestionario sobre el idioma que se habla en el hogar 19 TAC Chapter 89, Subchapter BB §89.1215

DEBE DE COMPLETARSE POR EL PADRE O TUTOR ESTUDIANTES QUE CURSEN DESDE PREKINDER HASTA EL OCTAVO GRADO: (O POR EL ESTUDIANTE SI CURSA GRADOS DEL 9-12): El estado de Texas requiere que la siguiente información se complete para cada estudiante que se matrícula por primera vez en una escuela pública de Texas. Es la responsabilidad del padre o tutor, no de la escuela, proporcionar la información del idioma requerida por las siguientes preguntas.

NOMBRE DEL ESTUDIANTE: ______________________________ ID#: _____________________________________

DIRECCIÓN: ____________________________________________ TELÉFONO: _______________________________

ESCUELA: ______________________________________________

Nota: Indique sólo un idioma por respuesta.

1. ¿Qué idioma se habla en casa la mayor parte del tiempo? _____________________________

2. ¿Qué idioma habla su hijo(a) la mayoría del tiempo? _____________________________

______________________________________________________ ____________________________ Firma del padre o tutor Fecha

______________________________________________________ __________________________ Firma del estudiante si esta en los grados 9-12 Fecha

Querido padre o guardián:

Para determinar si su hijo(a) se beneficiara de los servicios de los programas bilingües y/o de inglés como segundo idioma, por favor responda las dos preguntas siguientes.

Si cualquiera de sus respuestas indica el uso de un idioma que no sea inglés, entonces el distrito escolar debe realizar una evaluación para determinar que tanto se comunica su hijo(a) en inglés. Esta información de evaluación se usará para determinar si los servicios de programas bilingües y/o de inglés como segundo idioma son apropiados e informarán las recomendaciones en cuanto a la instrucción y la asignación del programa. Una vez completada la evaluación de su hijo(a), no se permitirán cambios a las respuestas en el cuestionario.

Si tiene preguntas sobre el propósito y el uso del cuestionario sobre el idioma que se habla en el hogar, o si necesita ayuda para completar el cuestionario, por favor comuníquese con el personal del distrito escolar.

Para más información sobre el proceso que debe seguirse, por favor visite el siguiente sitio web: https://projects.esc20.net/upload/page/0081/docs/LPAC-TrainingFlowchartSpanish-Accessible.pdf.

Este cuestionario se archivará en el expediente del estudiante.

https://projects.esc20.net/upload/page/0081/docs/LPAC-TrainingFlowchartSpanish-Accessible.pdf

2020-2021 Family Survey Date: District: PEARSALL ISD Campus:

Student Name: Date of Birth: Grade Level:

Dear Parents, In order to better serve your children, our school district is helping the State of Texas identify students who may qualify to receive additional educational services. Please answer the following questions and return this form to your child’s school. The information provided below will be kept confidential. Or, if you prefer, for more information, call: (210) 370-5401

1. Within the past 3 years have you, or your child, moved from one school district, city or state to another? YES NO 2. If YES, did you or your child move so you could work or look for work in agriculture or fishing?

NO (STOP here and return survey to your child’s school) YES ( Please check all that apply below)

Fruit, vegetables, sunflower, cotton, wheat, grain, on farms or ranches, fields & vineyards

Working in a cannery

Working on a dairy farm or ranch

☐

Working in a fishery

Working on a poultry farm

Working in a plant nursery, orchard, tree growing or

harvesting

Working in a slaugherhouse

Other similar work, please explain:

___________________________ ___________________________

3. Please list all children who reside in the home who are under age 22 and NOT enrolled in school:

Please complete the following information: (Please print) Name of Parent/Guardian: Phone Number:Address/City/State/Zip Code:

For School Use Only: Please email survey with two YES responses to [email protected] For ESC 20 Use Only: Rev: 2/19

1st Attempt: 2nd Attempt: 3rd Attempt:

2020-2021 Family Survey Fecha: Distrito: PEARSALL ISD Escuela:

Nombre del estudiante: Fecha de Nacimiento: Grado:

Estimados padres, Para mejorar los servicios de sus hijos, el distrito está colaborando con el estado de Texas para identificar a los estudiantes que pueden calificar para recibir servicios educativos adicionales. Toda la información proporcionada será mantenida confidencial. Favor de responder a las siguientes preguntas y regresar esta forma a la escuela de su hijo/hija. O, si lo prefieres, para obtener más información, llame al: (210) 370-5401

1. ¿Dentro de los últimos 3 años usted, o su hijo/hija, se ha mudado de distrito escolar, ciudad o estado? YES NO

2. ¿Si respondió SI, usted, o su hijo/a, se mudó para trabajar o buscar trabajo de agricultura o de pesca?

NO (ALTO Regrese la encuesta a la escuela de su hijo/a) YES ( FAVOR elija los que apliquen abajo)

Fruta, verduras, soya, girasol, algodón, trijo, betabel, la granja, ranchos, campos y viñedos

Trabajando enlatando frutas o verduras

Trabajando en una lechería o rancho

☐

Trabajando en la pesca

Trabajando en granjas de Aves

Trabajando en un vivero de plantas, plantando or cosechando arboles

Trabajando en una casa de matanza

Otro trabajo similar, favor de explicar:

___________________________ ___________________________

3. Favor de notar los niños que residen en el hogar que son menores de 22 años y que no están matriculados en laescuela:

Favor de llenar lo siguente: (Favor de usar letra de molde) Nombre de Padre/Guardina: Numbero de Telefono:Direccion de domicilio/Ciudad/Estado/Codigo Postal:

For School Use Only: Please email survey with two YES responses to [email protected] For ESC 20 Use Only: Rev: 2/19

1st Attempt: 2nd Attempt: 3rd Attempt:

1

PEARSALL INDEPENDENT SCHOOL DISTRICT 2020 - 2021

MILITARY CONNECTED STUDENT

STUDENT NAME:__________________________ STUDENT ID:_________

CAMPUS NAME: __________________________

If the parent/guardian is a uniformed member of the United States military service please check one of the following:

NOTE: The term "dependent", with respect to a member of a uniformed service, means the spouse of the member, an unmarried child of the member, an unmarried person who is placed in the legal custody of the member and is dependent on the member for over one-half of the person's support, resides with the member unless separated by the necessity of military service or to receive institutional care as a result of disability or incapacitation, or under such other circumstances as the Secretary concerned may by regulation prescribe and is not a dependent of a member under any other paragraph (37 USC Sec. 401).

_____ 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 United States military (Army, Navy, Air Force, Marine Corps, or Coast Guard).

_______4. Pre-kindergarten student is a dependent 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 members of the Reserve components of the Army, Navy, Marine Corps, Air Force, or Coast Guard; who are currently on active duty or who were injured or killed while serving on active duty.

Relationship to student: Father Mother Legal Guardian

Branch of Service:________________________________________

__________________________________ __________________________________ Signature of military parent/guardian Date

__________________________________ Print name

ALL STUDENTS ARE REQUIRED TO SIGN AND RETURN THIS PAGE BEFORE THE USE OF ANY TECHNOLOGY EQUIPMENT (PERSONAL OR DISTRICT-OWNED) IS ALLOWED AT PEARSALL ISD.

STUDENT AGREEMENT: As a user of the school’s technology resources, I understand and agree to comply with the netiquette and appropriate use guidelines outlined in the CQ Legal, CQ Local, FNCE Local, Student Acceptable Use of Technology, the Student Web Publishing, & the guidelines in the Responsible Use Technology Agreement form for Students. CONSEQUENCES FOR VIOLATION OF THIS AGREEMENT: Should I commit a violation, I understand that consequences of my actions could include suspension/loss of computer privileges or data and files, disciplinary action, and/or referral to law enforcement.

Student Name (print):__________________________________________________________

Student Signature:___________________________________________ Date:__________________________

As the parent or guardian of this student, I have read the CQ Legal, CQ Local, FNCE Local, Student Acceptable Use of Technology, & the Student Web Publishing Policies. I understand the conditions for use of the network and Internet resources provided byPearsall ISD and that access to technology resources are provided for the purpose of promoting education excellence in keeping with the academic goals of the District, and that student use for any other purpose is inappropriate. I recognize it is impossible for the District to restrict access to all controversial materials, and I will not hold the school responsible for materials acquired on the school network. I understand that children’s computer activities at home should be supervised as they can affect the academic environment at school. I understand that my child is responsible for any transactions that occur under his or her user ID or account, that any violation of that policy will be considered a violation of the Student Code of Conduct, and that my child may be denied access to the district’s technology resources in addition to any other disciplinary action.

I understand that from time to time the school may wish to publish examples of student projects or photographs of students on the School District’s website.

I hereby give permission for my child to use technology resources at Pearsall Independent School District.

Parent/Guardian's Name (print) _____________________________________________________________

Parent/Guardian's Signature: _________________________________ Date: _________________________


Student/Parent Technology Use Agreement Form 2020-2021

Cell Phone Return Receipt

Student Name: ________________________________________________________

Serial # _______________________________ Carrier ___________________ Make _________________

Local Policy FNCE- An authorized District employee may confiscate a personal telecommunications device, including a mobile telephone, used in violation of applicable campus rules. A confiscated personal telecommunications device shall be released for a fee determined by the Board. In accordance with the student handbook, the student or the student’s parents may retrieve the device after paying the fee. If a personal telecommunications device is not retrieved, the District shall dispose of the device after providing notice required by law.

District Policy – for safety purposes, the district permits students to possess telecommunications devices, including cell phone: however, these devices must remain turned off and out of sight during the instructional day, which includes during all testing. A student who uses or displays a telecommunications device during the school day shall have the device confiscated. Disciplinary action will be in accordance with the Pearsall ISD Student Code of Conduct. The district will not be responsible for damaged, lost, or stolen telecommunications devices. SIMS cards, if applicable will remain in the cell phone until the phone is picked up and the fee is paid.

A student shall obtain prior approval before using personal telecommunications or other personal electronic devices for on campus instructional purposes. Students will be allowed to use their cell phones before school and during lunch to listen to music only. However, the student must wear ear buds.

Violation 1st offense – Will result in Confiscation – a parent/guardian my pick up the cell phone the following school day with no fee. 2nd offense – Will result in Confiscation – a parent/guardian may pick up the cell phone the following school day with a payment of a $10 administrative fee. 3rd and thereafter offense – Will result in Confiscation – A parent/guardian may pick up the cell phone the following school day with a payment of a $15 administrative fee.

Parent Signature ___________________________ Date ________________ Offense # ______

White Copy Attach to Phone Yellow copy to Student File Pink copy to Parent

Confiscated Property Receipt

Staff Member Turning in Confiscated Property ________________________

Student Name _______________________________________ Date ___________

Description of Property; ________________________________________________

Property Released to ________________________________________ Initial _____

This confiscation must be entered into TxEIS as a teacher referral


Pearsall Independent School District 2020-2021 Selection & Acknowledgement of Instructional Setting

When Pearsall ISD re-opens, the Texas Education Agency (TEA) will allow on-campus or off-campus instruction. Therefore, parents will have the option to send their students to school or keep them at home for virtual/remote instruction. To help us plan for your child’s educational setting once PISD re-opens, please select your preference below for your child. As per TEA guidelines, if parents choose remote learning, and in the best educational interest of each child, a student may not return to on-campus instruction until the end of a 6-week grading period. By selecting one of the options below and submitting this form, I acknowledge that I have read and understand the student enrollment options presented by Pearsall ISD. _____ I will send my child back to campus for face-to-face instruction for the 2020-2021 school year. _____ I will keep my child at home for virtual/remote instruction for the 2020-2021 school year.

Pearsall Independent School District 2020-2021 Daily Screening & Re-Entry Acknowledgement

As required by the Texas Education Agency (TEA), when students are able to return on-site for instruction, I ensure that I will not send my child to school on campus if my child has COVID-19 symptoms (as listed below) or is lab confirmed with COVID-19. If my child is exhibiting symptoms or is lab-confirmed with COVID-19, I will opt for him/her to receive remote instruction until the conditions for re-entry are met (described in this document). I further understand that my child may need to receive remote instruction if my child has had close contact (as defined in this document) with an individual who is lab-confirmed with COVID-19 until the 14-day incubation period has passed. COVID-19 Symptoms

● Feeling feverish or a measured temperature greater than or equal to 100.0 degrees Fahrenheit ● Loss of taste or smell ● Cough ● Difficulty breathing ● Shortness of breath ● Headache ● Chills ● Sore throat ● Shaking or exaggerated shivering ● Significant muscle pain or ache ● Diarrhea

Conditions for Campus Re-Entry Requirements ● In the case of individual who was diagnosed with COVID-19, the individual may return to school when all three

of the following criteria are met 1. at least three days (72 hours) have passed since recovery (resolution of fever without the use of

fever-reducing medications); 2. the individual has improvement in symptoms (e.g., cough, shortness of breath, etc.); and 3. at least ten days have passed since symptoms first appeared.

● In the case of an individual who has symptoms that could be COVID-19 and who is not evaluated by a medical professional or test for COVID-19, such individual is assumed to have COVID-19, and the individual may not return to the campus until the individual has completed the same three-step set of criteria listed above.

● If the individual has symptoms that could be COVID-19 and wants to return to school before completing the above stay at home period, the individual must either (a) obtain a medical professional's note clearing the individual for return based on an alternative diagnosis or (b) receive two separate confirmation at least 24 hours apart hat they are free of COVID-19 via acute infection tests at an approved COVID-19 testing location found at https://tdem.texas.gov/covid-19/.

CDC Definition of "Close Contact" "Close contact" is determined by an appropriate public health agency. For clarity, "close contact" is defined as:

● being directly exposed to infections secretions (e.g., being coughed on while not wearing a face mask for face shield); or

● being within 6-feet for a cumulative duration of 15 minutes, while not wearing a face mask or face shield. If either occurred at any time in the last 14 days at the same time the infected individual was infectious. Individuals are presumed infectious at least two days prior to symptom onset or, in the case of asymptomatic individuals who are lab-confirmed with COVID-19, two days prior to the confirming lab test. _____ By checking this box and submitting this form, I acknowledge that I have read and understand the daily screening

requirements for my child as set by TEA and the District.

https://tdem.texas.gov/covid-19/

ALL STUDENTS ARE REQUIRED TO SIGN AND RETURN THIS PAGE BEFORE THE USE OF ANY TECHNOLOGY EQUIPMENT (PERSONAL OR DISTRICT-OWNED) IS ALLOWED AT PEARSALLISD.

STUDENT AGREEMENT: As a user of the school’s technology resources, I understand and agree to comply with the netiquette and appropriate use guidelines outlined in the CQ Legal, CQ Local, FNCE Local, Student Acceptable Use of Technology, the Student Web Publishing, & the guidelines in the Responsible Use Technology Agreement form for Students. CONSEQUENCES FOR VIOLTION OF THIS AGREEMENT: Should I commit a violation, I understand that consequences of my actions could include suspension/loss of computer privileges or data and files, disciplinary action, and/or referral to law enforcement.

Student Name (print):__________________________________________________________

Student Signature:___________________________________________ Date:__________________________

As the parent or guardian of this student, I have read the CQ Legal, CQ Local, FNCE Local, Student Acceptable Use of Technology, & the Student Web Publishing Policies. I understand the conditions for use of the network and Internet resources provided by Pearsall ISD and that access to technology resources are provided for the purpose of promoting education excellence in keeping with the academic goals of the District, and that student use for any other purpose is inappropriate. I recognize it is impossible for the District to restrict access to all controversial materials, and I will not hold the school responsible for materials acquired on the school network. I understand that children’s computer activities at home should be supervised as they can affect the academic environment at school. I understand that my child is responsible for any transactions that occur under his or her user ID or account, that any violation of that policy will be considered a violation of the Student Code of Conduct, and that my child may be denied access to the district’s technology resources in addition to any other disciplinary action.

I understand that from time to time the school may wish to publish examples of student projects or photographs of students on the School District’s website.

I hereby give permission for my child to use technology resources at Pearsall Independent School District.

Parent/Guardian's Name (print) _____________________________________________________________

Parent/Guardian's Signature: _________________________________ Date: _________________________


Student/Parent Technology Use Agreement Form 2020-2021

Please complete this section if you need to request a technology device from the district during the time of closure due to COVID-19. The device shall be use for instructional purposes only. I acknowledge that a device will be checked out to me and my child to use for instructional purposes only during the time of closure due to COVID-19. Failure to comply with the acknowledgment, may result in consequences for me and my child.

My child has a device for home useMy child will need a device for homeMy child has Internet service at homMy child will need Internet service a

use et home

2020-2021 New Student Packet TFE&INT.pdfNew Student Registration 19-2019-20 Student pick up formTranscript Request 19-20Acknowledgement Form 19- 20Attendance information form 19-20Health Services Form 19-20Intermediate/08

Imm Trac 2 minor consent form 19-20Tb Questionnaire 19-20Ethnicity form 19-20 engPearsall Independent School District

Ethnicity Form 19-20 spanishSRQ English 19-20SRQ Spanish 19-20Socioeconomic Information Form Spanish 2018-19HLS English 19-20HLS Spanish 19-20PEARSALL ISD 2019-2020 FAMILY SURVEYMilitary Connected formPISD Student Responsible use for Technology Agreement FormCell Phone Return Receipt 19-20

Registration Acknowledgements (COVID-19).pdf2020-2021 Device Request.pdfPISD Student Responsible use for Technology Agreement Form

TFE: OffPJH: OffINT: OffPHS: OffStudent Full Legal Name: Grade Level: Social Security Number: Student I: D:

Gender: Birth Place: Age Sept 1 2017: Physical Address: Bus Yes: OffBus No: OffPrevious School Attended: Guardian: Relation: Guardian_2: Relation_2: Address: Address_2: City State Zip: City State Zip_2: Employer: Employer_2: Cell: Home: Bus: Cell_2: Home_2: Bus_2: Drivers License #: Drivers License ##1GUARD2: Phone Preference Cell: OffHome_3: OffBusiness: OffPhone Preference Cell_2: OffHome_4: OffBusiness_2: OffEmail: Email_2: Receive Mailouts: OffY: OffLang for Mailouts: OffEnglish: OffReceive Mailouts_2: OffY_2: OffLang for Mailouts_2: OffEnglish_2: OffSvc Branch 1: Svc Branch 2: Rank: Svc Branch: Rank_2: Name: Relation_3: Cell_3: Home_5: Bus_3: Phone Preference: Name_2: Relation_4: Cell_4: Home_6: Bus_4: Phone Preference_2: Doctor Preference: Phone: Dentist Preference: Phone_2: Hospital Preference: Phone_3: Other Medical: Phone_4: List any allergies: BrothersSisters 1: BrothersSisters 2: Grade 1: Grade 2: School 1: School 2: BrothersSisters 1_2: BrothersSisters 2_2: Grade 1_2: Grade 2_2: School 1_2: School 2_2: Date of Birth_2: MALE: FEMALE: ADDRESS: MAILING: CITY: ZIP: FATHERS NAME: PHONE: WORK: MOTHERS NAME: PHONE_2: WORK_2: LEGAL GUARDIAN: PHONE_3: WORK_3: 1 Name: Relation#1PICKUP: Ph: Wk: 2 Name: Relation_2#1PICKUP: Ph_2: Wk_2: 3 Name: Relation_3#1PICKUP: Ph_3: Wk_3: 4 Name: Relation_4#1PICKUP: Ph_4: Wk_4: 5 Name: Relation_5: Ph_5: Wk_5: 6 Name: Relation_6: Ph_6: Wk_6: Date: Signature24_es_:signer:signature: Check Box2: OffCheck Box3: OffCheck Box54: OffCheck Box55: OffCheck Box56: OffCheck Box57: OffCheck Box58: OffCheck Box59: OffPrevious School Name: Address#2TRANSREQ: Address Continued#0TRANSREQ1: Address ContinuedTRANSREQ2: Earned Credits: OffGrades Earned: OffAchievement/STAAR/test scores: OffImmunization Records: OffRecords of Attendance: OffBirth Certificate: OffSocial Security: OffAny Programs: OffAny Other: OffGrade: Date of Birth: Student Name: ParentGuardian Name: Initial 1: Initial 2: Initial 3: Initial 4: Student 1: Grade 1#1ATTENDANCE: Student 2: Grade 2#1ATTENDANCE: Student 3: Grade 3: Student 4: Grade 4: Student 5: Grade 5: No more than 5 parent notes will be accepted per semester anything after will be: Once the student has 3 unexcused absences the parent will receive a warning letter and a: I have accepted the responsibility for accessing the district attendance policies on the: Signature of Parent/Guardian: Check Box 10: OffCheck Box 11: OffCheck Box 12: OffCheck Box 13: OffCheck Box 14: OffCheck Box 16: OffCheck Box 15: OffCheck Box 17: OffCheck Box 18: OffCheck Box 19: OffCheck Box 20: OffStudents Name: Teacher: Home Phone: Cell Phone: Home Address: Mailing Address: Last schools attended: Fathers Name: Employment: Phone#1HEALTH5: Mothers Name: Employment_2: Phone_2#1HEALTH6: Name#1HEALTH: Address#1HEALTH1: Phone_3#1HEATLH7: Name_2#1HEALTH3: Address_2#1HEALTH4: Phone_4#1HEALTH8: If yes to either both questions please indicate medication prescribed 1: If yes to either both questions please indicate medication prescribed 2: Please list any other health conditions about your child that you feel we at the school need to know about 1: Please list any other health conditions about your child that you feel we at the school need to know about 2: representative of the Pearsall Independent School District to refer my child to Dr: or if said physician cannot be reached then refer to Dr: Yes 2: OffNo 2: OffYes 3: OffNo 3: OffName of Child: If so specify which countrycountries: Date 2: Date 3: Date 4: Date 5: Yes symptoms/problems: OffYes my child: OffYes some one: OffYes born in other country: OffNo not born in other country: OffDon't know if other country: OffNo symptoms/problems: OffNo not my child: OffNo one: OffDon't know symptoms/problems: OffDon't know if my child: OffDon't know if anyone: OffYes Test: OffYes positive: OffNo tested: OffNo - postive: OffYes other country: OffNo Other country: OffDon't know other country: OffYes spent time: OffNo spent time: OffDon't know spent time: OffHispanicLatino A person of Cuban Mexican Puerto Rican South or Central American or other: OffNotHispanicLatino: OffAmerican Indian or Alaska Native A person having origins in any of the original peoples of North: OffAsian A person having origins in any of the original peoples of the Far East Southeast Asia or the: OffBlack or African American A person having origins in any of the black racial groups of Africa: OffNative Hawaiian or Other Pacific Islander A person having origins in any of the original peoples of: OffWhite A person having origins in any of the original peoples of Europe the Middle East or North: OffStudentStaff Name please print: Student/Staff ID Number: HispanoLatino Una persona de origen cubano mexicano puertorriqueño centro o sudamericano o de: OffNoHispanoLatino: OffIndio Americano o Nativo de Alaska Una persona con orígenes o de personas originarias de: Offsubcontinente indio incluyendo por ejemplo a Cambodia China India Japón Corea Malasia Pakistán las: OffNativo de Hawai u otras islas del pacífico Una persona con orígenes o de personas originarias: Blanco Una persona con orígenes de personas originarias de Europa el Medio Este o el Norte de: OffFirma del padre/Representante: Número de Identificación del: Negro o Africo-Americano: OffNombre del Estudiante/Miembro de personal: Name of Student: Current Address include City State and Zip: Work: OffNo phone: OffPrevious Address include City State and Zip: County: Last School Attended: OffOther 1: Other: Name of Person with whom student resides: Student lives with one parent or both parents every day of the school year C1923: OffStudent lives with a legal guardian appointed by a court every day of the school year: OffStudent is under 21 on September 1 of the 20182019 school year and does not live with a: OffCaregiver Examples friends relatives parents of friends: OffUnaccompanied Student C1924: OffStudent is currently in the conservatorship custody of the Department of Family and: OffStudent is currently in Foster Care and residing in a Foster or Group Home Foster ParentGroup: OffThe student lives here because of a natural disaster X the type of disaster below and provide the requested information: Flood: OffWildfire: OffHurricane: OffOtherPlease describe: OffThe student does not sleep in any of the places described above Tell below where the student does sleep: Namess of schoolaged siblings brothers andor sisters of the studentRow1: GradeRow1: B: OffS: Offundefined: OffList all other schoolaged children that stay in the same place as the studentRow1: GradeRow1_2: Namess of schoolaged siblings brothers andor sisters of the studentRow2: GradeRow2: B_2: OffS_2: Offundefined_2: OffList all other schoolaged children that stay in the same place as the studentRow2: GradeRow2_2: Namess of schoolaged siblings brothers andor sisters of the studentRow3: GradeRow3: B_3: OffS_3: Offundefined_3: OffList all other schoolaged children that stay in the same place as the studentRow3: GradeRow3_2: Namess of schoolaged siblings brothers andor sisters of the studentRow4: GradeRow4: B_4: OffS_4: Offundefined_4: OffList all other schoolaged children that stay in the same place as the studentRow4: GradeRow4_2: Namess of schoolaged siblings brothers andor sisters of the studentRow5: GradeRow5: B_5: OffS_5: Offundefined_5: OffList all other schoolaged children that stay in the same place as the studentRow5: GradeRow5_2: Telephone Number: Check Box 1: OffCheck Box 2: OffCheck Box 3: OffCheck Box 4: OffCheck Box 5: OffCheck Box 6: OffCheck Box 7: OffCheck Box 8: OffCheck Box 9: OffNombre de estudiante: Direccion Ciudad Estado y Codigo Postal: Celular: OffHogar: OffTrabajo: OffNo telefono: OffDireccion anterior Ciudada Estado y Codigo Postal: Condado: Ultima escuela que estuvo: OffTed Flores Elementary: OffPearsall Intermediate: OffPearsall Jr High: OffMay 2017: Offother 1: Nombre de la persona con quien vive el estudiante: Estudiante vive con uno o ambos padres todos los dias del ano escolar: OffEstudiante vive con el guardian legal designado por la corte: OffEstudiante es menor de edad en la fecha del 21 de Septiembre 20182019 ano escolar y no: OffCuidador Ejemplos amigo familiar padres de amigos: OffEstudiante no esta acompanado: OffEl estudiante esta actualmente en la custodia del Departamento de Familia Y Servicios de: OffEstudiante esta actualmente viviendo en un hogar sustituto Guardian Sustituto Temporal o: OffFecha: Inundacion: OffTornado: OffIncendio: OffHuracan: OffOtrapor favor explique: OffEl estudiante vive aqui por desastres naturales Marque X en el tipo de desastre: Explique donde vive el estudiante: Nombres de hermanos hermanas del estudiate de edad escuelanteRow1: GradoRow1: O: OffA: OffNo: OffListe todo otro nino a de edad escuelante que vive en el mismo lugar que el estudianteRow1: GradoRow1_2: Nombres de hermanos hermanas del estudiate de edad escuelanteRow2: GradoRow2: O_2: OffA_2: OffSi_2: OffNo_2: OffListe todo otro nino a de edad escuelante que vive en el mismo lugar que el estudianteRow2: GradoRow2_2: Nombres de hermanos hermanas del estudiate de edad escuelanteRow3: GradoRow3: O_3: OffA_3: OffSi_3: OffNo_3: OffListe todo otro nino a de edad escuelante que vive en el mismo lugar que el estudianteRow3: GradoRow3_2: Nombres de hermanos hermanas del estudiate de edad escuelanteRow4: GradoRow4: O_4: OffA_4: OffSi_4: OffNo_4: OffListe todo otro nino a de edad escuelante que vive en el mismo lugar que el estudianteRow4: GradoRow4_2: Nombres de hermanos hermanas del estudiate de edad escuelanteRow5: GradoRow5: O_5: OffA_5: OffSi_5: OffNo_5: OffSi No: Liste todo otro nino a de edad escuelante que vive en el mismo lugar que el estudianteSi No: GradoSi No: Numero De Telefono: Student Grade: Student Date of Birth: School Name: Do you receive Supplemental Nutrition Assistance SNAP: OffDo you receive Temporary Assistance to Needy Families TANF: OffHow many members are in the household include all adults and children: 44124 51634: Off51635 59145: Off59146 66656: Off66657 74167: Off0 21590: Off21591 29101: Off29102 36612: Off36613 44123: Off74168 81678: Off81679 89189: Off89190 96700: Off96701 104211: Off104212 111722: Off111723 119233: Off119234 126744: Off126745 and more: OffI certify that all the information on this form is true and that all income is reported I understand the school will: OffI choose not to provide this information I understand that the schools disbursement of federal funds and: OffParentGuardian Name Print: Nombre del estudiante: Grado: Nombre de la escuela: identificación del estudiante: 0 22459: Off22460 30451: Off30452 38443: Off38444 46435: Off46436 54427: Off54428 62419: Off62420 70411: Off70412 78403: Off78404 86395: Off86396 94388: Off94389 102380: Off102381 110373: Off110374 118366: Off118367 126359: Off126360 134356: Off134357 y mas: OffCuántos miembros hay en el hogar incluya todos los adultos y niños: Nombre del Padre: Firma del Padre: Initial: OffYes SNAP: OffNo SNAP: OffYes TANF: OffNo TANF: OffSTUDENT NAME: STUDENT ID: ADDRESS#1HLS: TELEPHONE: CAMPUS: WHAT LANGUAGE IS SPOKEN IN HOME: LANGUAGE CHILD SPEAKS: SIGNATURE: DATE: DATE 2: Language Proficiency Assessment Committee LPAC_2: NOMBRE DEL ESTUDIANTE: ID: DIRECCIÓN: TELÉFONO: ESCUELA: Qué idioma se habla en casa la mayor parte del tiempo: Qué idioma habla su hijoa la mayoría del tiempo: Firma del padre o tutor: Firma del estudiante si esta en los grados 912: Fecha_2: Campus: yes: OffYes: OffFruit, Vegetable Ranch: OffCannery: OffDairy Farm/Ranch: OffFishery: OffPoltry Farm: OffPlant Nursery/Orchard: OffSlaugherhouse: OffAll Children who reside in the home under age 22 not in school: Name of Parent/Guardian: Phone Number: Address#1FS: Escuela: Nombre de Estudiante: Fecha de Nacimiento: Si: OffFruta/Verduras/Soya/Girasol/Algodon/Trijo/Betabel/Granja/Ranchos/Campos/Vinedos: OffEnlatando Frutas o Verduras: OffLecheria o Rancho: OffPesca: OffGranjas de Aves: OffVivero de Plantas/Plantando/Cosechando Arboles: Offcasa de matanza: OffOtro: Notar los ninos que residen en el hogar que son menores de 22 anos y que no estan matriculados en la escuela: Nombre de Padre/Guardian: Numbero de Telefono: Direccion: Campus Name: Student ID: Dependent of Military Member: OffDependent of Texas National Guard Member: OffDependent of member of a reserve force in the US Military: OffPre-K dependent: OffFather: OffMother: OffLegal Guardian: OffBranch of Service: Print Name: Student Name print: ParentGuardians Name print: Date_2: Serial #: Carrier: Make: Offense #: Staff Member: Student Name#5RETURN: Description of Property: Property Released to: SAISCheck Box1: 0: Off1: Off

SAISCheck Box2: Off

Pearsall Independent School District Registration Form for ......Occasionally, Pearsall ISD wishes...

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Transcript of Pearsall Independent School District Registration Form for ......Occasionally, Pearsall ISD wishes...