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New Student Packet
Eman Schools - New Student Information
Step
1
of
6
- Student Information
0%
Registration Fees
*
I will send a check for $50
Add $50 on my Facts account balance
Student Name
*
First
Last
Date of Birth
*
Month
1
2
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5
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12
Day
1
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Year
2023
2022
2021
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2013
2012
2011
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1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Place of Birth
*
Gender
*
Female
Male
Current School
*
Current Grade
*
No School before
PS (3yr)
PK (4 yr)
KG (5 r)
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
(or grade completed)
Grade Applying to
*
PS (3yr)
PK (4 yr)
KG (5 r)
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
(for School Year 2021-2022)
PreK Options
*
Please choose one of the PreK attendance options. PreK Full Time: Mon-Fri: 8am - 3:30 PreK Part Time: Mo-Fri: 8:am - noon
Full Time (5 full days)
Part Time (5 half days)
https://www.emanschool.net/wp-content/uploads/2021/03/Eman-PS-Brochure2.pdfhttps://www.emanschool.net/support/new-student-packet/
Home Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
*
Race (for State reporting purpose only)
*
Asian
Black
Hispanic
White
Multiracial
Other
Student Lives with
*
Parents
Other
Provide more info
Does your child have any special needs and will need accommodation?
*
No
Yes
What kind?
*
IEP
504 Plan
Other
Has your child ever been suspended or expelled from school?
*
No
Yes
Please provide details on suspension or expulsion:
*
Mother's Name
*
First
Last
Mother's Phone
*
Mother's Email
*
Mother's Address same as Student?
*
Yes
No
Mother's Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Mother's Occupation
Mother's Employer
Father's Name
*
First
Last
Father's Phone
*
Father's Email
*
Father's Address same as Student?
*
Yes
No
Father's Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Father's Occupation
*
Father's Employer
What is the native language of the student?
*
What language(s) is spoken most often by the student?
*
What language (s) is spoken by the student in the home?
*
If a language other than English is indicated for any of the questions above, the student is considered to be a language minority student. Once this determination has been made, an English proficiency assessment must be administered to the student within 30 days of the start of school (or within 2 weeks for late enrollees) and annually thereafter to assess the level (1-5) of English proficiency and measure growth annually. For more information, you can visit the Indiana Department of Education’s Division of Language Minority and Migrant Programs website at: http://www.doe.state.in.us/lmmp/welcome.html
*
If a language other than English is indicated for any of the questions above, the student is considered to be a language minority student. Once this determination has been made, an English proficiency assessment must be administered to the student within 30 days of the start of school (or within 2 weeks for late enrollees) and annually thereafter to assess the level (1-5) of English proficiency and measure growth annually. For more information, you can visit the Indiana Department of Education’s Division of Language Minority and Migrant Programs website at: http://www.doe.state.in.us/lmmp/welcome.html
I agree
Internet Acceptable Use Policy Agreement
*
Student: I agree
Parent: I agree
1. Students must have a signed AUP agreement on file before using the Internet at school. 2. Parents must sign the AUP agreement to indicate parental permission for student’s use of the Internet at school. 3. Students with signed agreements may use the Internet in the classroom only under the supervision of a school staff member. We have read, understand, and agree to abide by Eman Schools’ Acceptable Use Policy and guidelines. Please ask the school office if you want a copy of the agreement.
Does your child have a history of the following:
Convulsions
Diabetes
Tonsillitis
Urinary Problems
Bronchitis
Other
None of the above
Has your child had any of the following illnesses?
*
Chicken Pox
Rheumatic Fever
Scarlet Fever
Hepatitis
Measles
Whooping Cough
Mumps
Other
None of the above
Does your child wear any of the following:
*
Glasses
Contacts
Hearing Aids
None of the above
Does your child carry an inhaler?
*
Yes
No
Does your child carry an EpiPen?
*
Yes
No
Please provide details on the allergies:
*
Has your child had a serious accident?
*
Yes
No
Please provide details of the accident:
*
Has your child ever been in the hospital?
*
Yes
No
Please provide details of the hospitalization:
*
Has your child ever had an operation/surgery?
*
Yes
No
Please provide details of the surgeries/operation:
*
May age appropriate dose of medicine be administered without verbal consent?
*
No
Tylenol
Ibuprofen
Tums
Cough Drops
Please explain any problems or concerns that school personnel should be aware of:
*
Please write NONE if there isn't anything.
Emergency Contact Name 1
*
First
Last
Person to contact in an emergency if Parent/Guardian not available:
Phone # of Emergency Contact 1
*
Emergency Contact Name 2
First
Last
Person to contact in an emergency if Parent/Guardian not available:
Phone # of Emergency Contact 2
Primary Physician Name
First
Last
Phone # of Primary Physician
Date of last physical:
Dentist Name
First
Last
Phone # of Dentist
Date of last dental check up:
In the event of an emergency, your child will be taken to the nearest hospital for treatment. Please indicate if you have a preference of the hospital:
Please choose:
*
Select All
I give Emergency Personnel permission to transport my child to an Emergency Room for treatment in my absence.
I grant my permission for the staff at the Emergency Room to treat my child.
I grant permission for the school to release all medical information that they have to the Emergency Room Personnel.
Students Records
*
Eman Schools considers the records of all individual students to be confidential information. Student records will be released ONLY to other schools or agencies upon receipt of all outstanding fees, dues, and tuition accounts have been paid in full.
I agree
Please upload a copy of student's Birth Certificate:
Max. file size: 256 MB.
Please upload the student's Birth Certificate here or email to accounting@emanschool.net. Your application will be not be considered complete until Eman Schools receive this file.
Please upload a copy of student's Immunization:
Max. file size: 256 MB.
Please upload the student's Immunization here or email to accounting@emanschool.net. Your application will be not be considered complete until Eman Schools receive this file.
Please sign Father's Name:
*
By clicking on SUBMIT button, I verify that I have provided all the information to the best of my knowledge.
Please sign Mother's Name:
*
By clicking on SUBMIT button, I verify that I have provided all the information to the best of my knowledge.
Today's Date
*
MM slash DD slash YYYY
Visit our Pre-K page
https://www.emanschool.net/school/pre-school/