SATSUMA HIGH SCHOOL Enrollment Packet

Forms Required No. of Pages

Attached New

Students Existing Students

Enrollment Card 1 X X X

Employment Survey 1 X X

Health Assessment Record 2 X X X

Home Language Survey 1 X X

Parent Technology Survey 1 X X X

School-Parent Compact 1 X X X

Student “Pick Up” Affidavit 1 X X X

Alabama Immunization Certificate X

Birth Certificate X

Parent/Guardian Picture ID X X

Social Security Card X

Two Proofs of Residence1 X X

Report Card (7-8 grade students only) X

Unofficial Trascript (9-12 grade students only) X

Other Forms Reason

Residency Affadavit The lease MUST be in the property owners' names, and you MUST be the legal guardian of the student. If you live with someone else, you must complete a Residency Affidavit for Property Owners and Property Managers. This form must be signed by you and the property owner, and it must be Notarized.

Custody Papers Required for a legal guardian other than parent on birth certificate.

1 A mortgage statement; a gas, electric, or water bill; or a lease signed by the property owners.

ALABAMA STATE DEPARTMENT OF EDUCATION EMPLOYMENT SURVEY

SCHOOL SYSTEM: Satsuma City Schools SCHOOL YEAR: 2014-2015 SCHOOL: __________________________________________ GRADE:_______ Dear Parents or Guardians, Please complete the following survey. The results of this survey will be used to determine if you are possibly eligible for the Migrant Education Program. Student Name: _____________________________________________________ Name of Parent or Guardian: __________________________________________ Address: __________________________________________________________ Telephone Number: _________________________________________________ 1. Have you moved during the last 3 years to work or to seek work even if it was for a short period of time? YES ____ NO ____ 2. Are you or your spouse working or have you worked in an activity directly related to some of the following? Please, check (√) all applicable:

The production or process of harvests, milk products, poultry farms,

poultry plants, cattle farms Fruit farms

The cultivation or cutting of trees

Work in nurseries or sod farms

Fish or shrimp farms

Worm farms

Catching or processing sea food (shrimp, oysters, crabs, fish, etc……) 3. From what city, state or country did you come from? _________________ ____________________________________________________________ 4. What type of work did you or your spouse do before coming here? _____ ____________________________________________________________ Revised: 6/1/08 V.2

Satsuma High School Parent Technology Survey

Circle the all that apply.

- I have a home computer. Yes No No, but planning on it.

- I have access to the internet. Yes No No, but planning on it.

- I use a computer for work. Yes No

- Locations where I use the internet. Home Work Library Friend’s Relative’s

Other _______________________________

Answer each question according to the following:

1=No Opinion 2=Strongly Disagree 3=Disagree 4=Agree 5=Strongly Disagree

- I have good computer skills. 1 2 3 4 5

- I am comfortable working with different technologies (e.g.

iPad, Smartphone, laptop, etc.) 1 2 3 4 5

- I have good overall knowledge of technology. 1 2 3 4 5

- Technology is critical to the learning experience of students. 1 2 3 4 5

- I would support additional funding for technology use with

learning. 1 2 3 4 5

Answer the following questions pertaining to your student’s use of technology.

- My student has regular and adequate access to technology in

the school. 1 2 3 4 5

- My student is knowledgeable on how to use various

technologies. 1 2 3 4 5

- My student has access to a computer outside of school for

school work. 1 2 3 4 5

- My studentt frequently uses technology for homework. 1 2 3 4 5

- I assist my student in using a computer for school work. 1 2 3 4 5

- My student plays games on a home computer. 1 2 3 4 5

- I have a good understanding of the ways my student uses

technology in school. 1 2 3 4 5

- I use iNow Parent Portal on a regular basis to access my

student’s grades, etc. 1 2 3 4 5

- Among all the needs facing schools today, where would you

rank technology in importance? (1=Low, 10=High) 1 2 3 4 5 6 7 8 9 10

STUDENT “PICK UP” AFFIDAVIT

Persons of less than 21 years of age may be listed but cannot pick up students unless a

signed affidavit is on file.

I (parent/guardian) _______________________________ grant the person listed below

permission to pick up the following students:

_______________________________ ___________________________________

_______________________________ ___________________________________

_______________________________ ___________________________________

_______________________________ ___________________________________

I am aware that ________________________________ is less than 21 years of age.

Signature: ________________________________

Date: __________________

SS-02 Satsuma City School System Rev. 12/2012 SATSUMA HIGH SCHOOL

RESIDENCY AFFIDAVIT School

FOR PROPERTY OWNERS & PROPERTY MANAGERS

Enrollment Date

I. Ownership/Management Declaration (completed by property owner or manager)

I, , currently (circle one) own / manage the residence located at the following address:

Street/Apt. # City ST Zip Code

Telephone Subdivision/Apt. Complex/Mobile Home Park

II. Rental/Occupancy Declaration (completed by property owner or manager)

I currently rent/lease this residence to the following: Name

I currently allow the following to occupy this residence: Name

The following school-aged child(ren) reside at said address on a full-time basis:

III. Property Declaration (completed by property owner or manager)

The following information can be documented by (a) owner’s current tax bill, (b) the property purchase/closing information, or (c) accessing the

Tax Assessor’s Database located on the Mobile County Property Tax website at http://www.mobile-propertytaxal.com and clicking the Tax

Bill/Search link at the top of the page.

(A) Mobile County Property Tax – Key No.

(B) Property Owner’s Name

IV. Additional Declarations (completed by enrolling parent/guardian)

I declare that all the facts contained herein are based upon my personal knowledge and are true and correct.

My student(s) listed above reside(s) with me five (5) days per week at the address listed above, which is my primary residence.

I understand that this affidavit is only applicable this school year.

I understand that representatives of the SCSS may visit said renters/occupants at the address set forth to verify the contents of this affidavit.

I agree to notify the school within five (5) days when I change my residence.

I understand that Parents/Court Appointed Legal Guardians are responsible for giving accurate and up to date information regarding

legal addresses and contact information to school officials. Giving false information to public officials in the performance of his or her

duty is a violation of the Criminal Code of Alabama §13A-10-109(a) and punishable by a fine of $500.00 and up to 90 days in jail.

SCSS may refer cases in which false information has been intentionally provided to the Mobile County District Attorney’s office for further

action and/or file a civil action to recover damages incurred as a result of providing false information.

Persons who induce, obtain, or otherwise solicit another person to provide false information on an affidavit are subject to the same criminal

prosecution, fines, and imprisonment as the person directly committing perjury.

Investigations that reveal students have enrolled on the basis of false information will lead to immediate disenrollment from SCSS.

SWORN TO AND SUBSCRIBED BEFORE ME,

THIS THE _______ DAY

OF _______________________, 20______ .

Notary Public

UNDER PENALTY OF LAW (§13A-10-109), I

SWEAR THAT THE INFORMATION GIVEN ABOVE IS TRUE AND CORRECT,

THIS THE _______ DAY

OF _______________________, 20______ .

Property Owner / Manager

Initial

Initial

Initial

Initial

Initial

Initial

Initial

Initial

Initial

UNDER PENALTY OF LAW (§13A-10-109), I

SWEAR THAT THE INFORMATION GIVEN ABOVE IS TRUE AND CORRECT,

THIS THE _______ DAY

OF _______________________, 20______ .

Parent/Guardian